Elsevier

World Neurosurgery

Volume 150, June 2021, Pages e777-e782
World Neurosurgery

Original Article
Robotic Assistance for Minimally Invasive Cervical Pedicle Instrumentation: Report on Feasibility and Safety

https://doi.org/10.1016/j.wneu.2021.03.150Get rights and content

Background

Accurate screw placement remains challenging, especially in the cervical spine. We present our first experience of minimally invasive posterior cervical and upper thoracic pedicle screw fixation in the lower cervical spine.

Methods

This study reports a case series of patients, undergoing posterior percutaneous pedicle fixation using Cirq robotic assistance coupled to the Airo intraoperative computed tomography scan and Brainlab navigation system. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated.

Results

Between February 2020 and December 2020, 7 patients (4 men and 3 women) were treated. The mean age was 58.8 years (range, 29–75 years). Fixation was performed with a cannulated PASS OCT Reconstruction System (Medicrea). Overall, 28 screws were placed within cervical and upper thoracic pedicles. According to the Neo and Heary classification, 85.7% were rated as acceptable and 14.3% as poor. The radiation dose received by the patient was 9.1 mSv (range, 7.7–10.6 mSv). The radiation dose received by the surgical staff was 0 mSv. The postoperative course was excellent.

Conclusions

Posterior miniopen fixation using Cirq robotic assistance coupled with an intraoperative computed tomography navigation system is a major innovation that can improve the accuracy of pedicle screw positioning, with acceptable patient radiation and reduced surgical team exposure.

Introduction

Posterior cervical spine fixation is a valuable surgical technique commonly performed to treat various degenerative, neoplastic, infectious, and traumatic conditions affecting the cervical spine. Most common screw fixation techniques include lateral mass, pedicle, intralaminar, and transfacet screws.1,2

Cervical transpedicular screw fixation (CTSF) offers more biomechanical stability than do other types of internal fixation, including lateral mass screw.3 However, CTSF placement is technically demanding, and the rate of screw malpositioning was reported as 6.7%–29.1% in conventional fluoroscopy procedures.4, 5, 6, 7 This procedure can be performed through an open or minimally invasive approach.

The fundamental aim of minimally invasive techniques is the reduction of approach-related morbidity secondary to muscle trauma, blood loss, and postoperative neck pain.8,9

Navigation techniques can also be used for CTSF. However, no previous reports have described the accuracy of CTSF using Cirq robotic assistance (Brainlab AG, Munich, Germany). in conjunction with intraoperative computed tomography (iCT) scan navigation via a minimally invasive approach.

We present our first experience using this technique for cervical and upper thoracic transpedicular screw fixation.

Section snippets

Patient Selection

We report a retrospective study carried out in our institution. Eligible patients were 18 years old or older, undergoing a complementary second-stage miniopen transpedicular screw instrumentation of the lower cervical and/or upper thoracic spine, for trauma, tumor, spondylodiscitis, or degenerative spinal diseases using intraoperative Airo computed tomography (CT) scan in conjunction with BrainLab curve navigation, Cirq robotic assistance (Brainlab AG, Munich, Germany).

All patients had

Patient Population

Between February 2020 and December 2020, 7 patients (4 men and 3 women) underwent miniopen transpedicular cervical spine screw instrumentation (Table 1).

The mean age was 58.8 years (range, 29–75 years). The mean body mass index was 24.8 kg/m2 (range, 17.1–38.05 kg/m2).

Five operations were performed for traumatic spine injury (71.4%), 1 for bone metastasis (14.3%), and 1 for infection (14.3%).

The mean surgical time was 115.7 minutes (range, 90–180 minutes). Mean blood loss was 292 mL.

Accuracy of Pedicle Screw Placement

Revision of

Discussion

The accuracy and technical advances in CTSF using the Cirq robotic assistance in conjunction with iCT scan navigation were investigated.

CTSF has more advantages than fixation through the spinous process, lamina, and anterior intervertebral plate, but because of anatomic complexity and possible severe complications, the application of CTSF has been limited.13

CTSF is an established technique for spinal stabilization and deformity correction. Its biomechanical advantages include increased bony

Conclusions

Posterior miniopen fixation using Cirq robotic assistance coupled with iCT navigation system is a major innovation that can improve the accuracy of pedicle screw positioning in the lower cervical and upper thoracic spine. The procedure is associated with acceptable patient radiation and reduced surgical team exposure. Future studies are needed to assess reproducibility, pedicle screw positioning, radiation exposure, and cost-effectiveness.

CRediT authorship contribution statement

Kaissar Farah: Conceptualization, Methodology, Writing - original draft, Writing - review & editing. Mikael Meyer: Conceptualization, Writing - original draft, Writing - review & editing. Solene Prost: Writing - original draft, Writing - review & editing. Faisal Albader: Writing - original draft, Writing - review & editing. Henry Dufour: Writing - review & editing. Benjamin Blondel: Writing - review & editing, Supervision. Stephane Fuentes: Conceptualization, Methodology, Writing - review &

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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