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Robotic-assisted cortical bone trajectory (CBT) screws using the Mazor X Stealth Edition (MXSE) system: workflow and technical tips for safe and efficient use

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Abstract

Robotic-assisted spine surgery has a number of potential advantages, including more precise pre-operative planning, a high degree of accuracy in screw placement, and significantly reduced radiation exposure to the surgical team. While the current primary goal of these systems is to improve the safety of spine surgery by increasing screw accuracy, there are a number of technical errors that may increase the risk of screw malposition. Given the learning curve associated with this technology, it is important for the surgeon to have a thorough understanding of all required steps. In this article, we will demonstrate the setup and workflow of a combined navigation and robotic spine surgery platform using the Mazor X Stealth Edition (MXSE) system to place cortical-based trajectory (CBT) screws, including a review of all technical tips and pearls to efficiently perform this procedure with minimal risk of screw malposition. In this article, we will review surgical planning, operating room setup, robotic arm mounting, registration, and CBT screw placement using the MXSE system.

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Authors and Affiliations

Authors

Contributions

Dr. JB and Dr. JG were involved in the creation, writing, and final editing of this publication. Drs. CG, RL, JP, AB, and RC were involved in the creation of the review, revised it critically for intellectual content, and approved the final version to be published. All authors involved agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors of this manuscript certify that it is (1) is a unique submission, (2) has not been submitted and is not being considered for publication by any other source in any medium, and (3) has not been published, in part or in full, in any form.

Corresponding author

Correspondence to Jeffrey L. Gum.

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Conflicts of interest

John Buza has no conflicts of interest. Jeffrey Gum has the following disclosures: Acuity: IP royalties, Paid consultant;; Cingulate Therapeutics, Stock or stock Options; DePuy, A Johnson & Johnson Company, Paid presenter or speaker; K2M, Paid consultant; MAZOR Surgical Technologies, Paid consultant; Medtronic, Paid consultant; Nuvasive, IP royalties, Paid consultant; Stryker, Paid presenter or speaker; Spine Deformity Journal—Reviewer, Editorial or governing board; The Spine Journal—Reviewer, Editorial or governing board. Ronald Lehman has the following disclosures: Medtronic: Consulting fees and royalties; Stryker: Royalty fees. Richard Chua has the following disclosures: Indirect interest as a consultant/speaker’s bureau related to surgeon education. Avery Buchholz has the following disclosures: Medtronic: Consulting fees. John Pollina has the following disclosures: Atec Spine: Consulting fees and royalties; Medtronic: Surgeon Education, Christopher Good has the following disclosures: Mazor Robotics: Stock options, consulting fees; Medtronic: Consulting, advisory board; Stryker/K2M: Consulting, Royalties, Advisory Board; Augmedics: Advisory Board, Stock Options; National Spine Health Foundation: Board Member.

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Buza, J.A., Good, C.R., Lehman, R.A. et al. Robotic-assisted cortical bone trajectory (CBT) screws using the Mazor X Stealth Edition (MXSE) system: workflow and technical tips for safe and efficient use. J Robotic Surg 15, 13–23 (2021). https://doi.org/10.1007/s11701-020-01147-7

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  • DOI: https://doi.org/10.1007/s11701-020-01147-7

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