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Research ArticleNew Technology

Robotic-Assisted Revision Spine Surgery

Alexander M. Satin, Stanley Kisinde and Isador H. Lieberman
International Journal of Spine Surgery June 2022, 8272; DOI: https://doi.org/10.14444/8272
Alexander M. Satin
1 Texas Back Institute, Plano, Texas, USA
MD
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Stanley Kisinde
1 Texas Back Institute, Plano, Texas, USA
MBChB, MMed
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Isador H. Lieberman
1 Texas Back Institute, Plano, Texas, USA
MD, MBA, FRCSC
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  • Figure 1
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    Figure 1

    Case 1: Lumbar spine anteroposterior and lateral standing radiographic images of the lumbosacral spine demonstrated intact hardware from L4 to S1, evidence of an iatrogenic flat back, grade I spondylolisthesis of L4-L5 level, grade I adjacent segment spondylolisthesis at the L3-L4 level, and increased proximal lumbar lordosis to compensate for her iatrogenic flat back.

  • Figure 2
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    Figure 2

    Case 1: Lumbar spine magnetic resonance images verified adjacent segment deterioration at the L3-L4 level as well as reduction in the degree of spondylolisthesis in comparison to the standing radiographic images. There was also evidence of central and lateral recess stenosis and a disc herniation at this level.

  • Figure 3
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    Figure 3

    Case 1: Computed tomography images after stage II confirmed substantial restoration of lordosis and reduction of the spondylolisthesis at both the previously fused L4-L5 level as well as the adjacent L3-L4 level.

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    Figure 4

    Case 1: Preoperative planning for robotic-assisted placement of pedicle screws.

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    Figure 5

    Case 1: Postoperative EOS ImagingTM (Electro Optical System) full-length spine radiographs demonstrate reduction of the spondylolisthesis and restoration of spinopelvic and sagittal parameters. PT, sagittal pelvic tilt; PI, pelvic incidence; SS, sacral slope; LL, lumbar lordosis; PI-LL, PI-LL mismatch; TK, thoracic kyphosis; TPA, T1 pelvic angle; SVA, sagittal vertical axis; C7PL, C7 plumb line; MC, major Cobb angle.

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    Figure 6

    Case 2: Preoperative EOS ImagingTM (Electro Optical System) full-length spine films revealed Harrington rod fixation across the thoracolumbar spine with degenerative changes most pronounced from L4 to S1. PT, sagittal pelvic tilt; PI, pelvic incidence; SS, sacral slope; LL, lumbar lordosis; PI-LL, PI-LL mismatch; TK, thoracic kyphosis; TPA, T1 pelvic angle; SVA, sagittal vertical axis; C7PL, C7 plumb line; MC, major Cobb angle.

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    Figure 7

    Case 2: Computed tomography images revealed end-stage deterioration at the L4-L5 and L5-S1 levels, with foraminal stenosis at both those levels. The proximal fusion was well healed with a solid posterior fusion mass.

  • Figure 8
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    Figure 8

    Case 2: Computed tomography images after stage I anterior fusion.

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    Figure 9

    Case 2: Preoperative planning for robotic-assisted placement of pedicle screws. Note that screws placed through fusion mass where anatomic landmarks are lost.

  • Figure 10
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    Figure 10

    Case 2: EOS ImagingTM (Electro Optical System) full-length spine radiographic images after stage II posterior reconstruction revealed significant improvement in lumbar lordosis and sagittal parameters. PT, sagittal pelvic tilt; PI, pelvic incidence; SS, sacral slope; LL, lumbar lordosis; PI-LL, PI-LL mismatch; TK, thoracic kyphosis; TPA, T1 pelvic angle; SVA, sagittal vertical axis; C7PL, C7 plumb line; MC, major Cobb angle.

  • Figure 11
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    Figure 11

    Case 3: Cervical spine anteroposterior and lateral radiographs demonstrate kyphotic sagittal alignment of the cervical spine with a grade II anterolisthesis of C2 on C3, autofusion of C3 and C4, and retrolisthesis of C4 on C5. Prior instrumented fusion of C5-C6 with anterior plating and posterior lateral mass screw that appeared to be intact.

  • Figure 12
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    Figure 12

    Case 3: Full-spine radiographs demonstrate the patient’s chin-on-chest deformity.

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    Figure 13

    Case 3: Preoperative cervical spine computed tomography images. The images showed loss of disc space height at C6-C7, evidence of laminectomies from C3 to C6, and evidence of autofusion at the C3-C4 level.

  • Figure 14
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    Figure 14

    Case 3: Preoperative planning for robotic-assisted placement of cervical pedicle screws.

  • Figure 15
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    Figure 15

    Case 3: Postoperative radiographic images show the final construct with pedicle screw fixation and deformity correction.

  • Figure 16
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    Figure 16

    Case 3: Pre- and postoperative lateral radiographs demonstrate significant improvement in sagittal alignment (normal range for CBVA20.

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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Robotic-Assisted Revision Spine Surgery
Alexander M. Satin, Stanley Kisinde, Isador H. Lieberman
International Journal of Spine Surgery Jun 2022, 8272; DOI: 10.14444/8272

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Robotic-Assisted Revision Spine Surgery
Alexander M. Satin, Stanley Kisinde, Isador H. Lieberman
International Journal of Spine Surgery Jun 2022, 8272; DOI: 10.14444/8272
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More in this TOC Section

  • High Uptake Detection for Spinal Degenerative Changes: A Comparison Between Bone Scintigraphy and Single Photon Emission Computed Tomography Combined With High-Resolution Computed Tomography
  • Accuracy of Pedicle Screw Placement Using the ExcelsiusGPS Robotic Navigation Platform: An Analysis of 728 Screws
  • A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems
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Keywords

  • revision spine surgical procedures
  • altered osseous anatomy
  • preoperative planning
  • robotic planning software
  • computer-assisted robotic guidance

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