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Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population

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Abstract

This is a retrospective review of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients under 18 years of age who underwent robot-assisted corrective surgery. Our primary objective was to characterize the accuracy of pedicle screw placement with evaluation by computed tomography (CT) after robot-assisted surgery in AIS patients. Screw malposition is the most frequent complication of pedicle screw placement and is more frequent in AIS. Given the potential for serious complications, the need for improved accuracy of screw placement has spurred multiple innovations including robot-assisted guidance devices. No studies to date have evaluated this robot-assisted technique using CT exclusively within the AIS population. Fifty patients were included in the study. All operative procedures were performed at a single institution by a single pediatric orthopedic surgeon. We evaluated the grade of screw breach, the direction of screw breach, and the positioning of the patient for preoperative scan (supine versus prone). Of 662 screws evaluated, 48 screws (7.2 %) demonstrated a breach of greater than 2 mm. With preoperative prone position CT scanning, only 2.4 % of screws were found to have this degree of breach. Medial malposition was found in 3 % of screws, a rate which decreased to 0 % with preoperative prone position scanning. Based on our results, we conclude that the proper use of image-guided robot-assisted surgery can improve the accuracy and safety of thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis. This is the first study to evaluate the accuracy of pedicle screw placement using CT assessment in robot-assisted surgical correction of patients with AIS. In our study, the robot-assisted screw misplacement rate was lower than similarly constructed studies evaluating conventional (non-robot-assisted) procedures. If patients are preoperatively scanned in the prone position, the misplacement rate is further decreased.

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References

  1. Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7(1):3–9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kim H, Kim HS, Moon ES et al (2010) Scoliosis imaging: what radiologists should know. Radiographics 30(7):1823–1842

    Article  PubMed  Google Scholar 

  3. Matsumoto M, Watanabe K, Hosogane N et al (2014) Updates on surgical treatments for pediatric scoliosis. J Orthop Sci 19(1):6–14

    Article  PubMed  PubMed Central  Google Scholar 

  4. Watanabe K, Lenke LG, Matsumoto M et al (2010) A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine 35:1836–1842

    Article  PubMed  Google Scholar 

  5. Marcus HJ, Cundy TP, Nandi D et al (2014) Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J 23(2):291–297

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lee Z, Lee JYK, Welch WC et al (2013) Technique and surgical outcomes of robot-assisted anterior lumbar interbody fusion. J Robot Surg 7(2):177–185

    Article  CAS  PubMed  Google Scholar 

  7. Hu X, Ohnmeiss DD, Lieberman IH (2013) Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients. Eur Spine J 22(3):661–666

    Article  PubMed  PubMed Central  Google Scholar 

  8. Devito DP, Kaplan L, Dietl R et al (2010) Clinical acceptance and accuracy assessment of spinal implants guided with Spine assist surgical robot: retrospective study. Spine 35(24):2109–2115

    Article  PubMed  Google Scholar 

  9. Hicks JM, Singla A, Shen F et al (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine 35:465–470

    Article  Google Scholar 

  10. Zhu F, Sun X, Qiao J et al (2013) Misplacement pattern of pedicle screws in pediatric patients with spinal deformity: a computed tomography study. J Spinal Disord Tech (epub ahead of print)

  11. Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine 26:2049–2057

    Article  CAS  PubMed  Google Scholar 

  12. Abul-Kassim K, Ohlin A, Strombeck A et al (2010) Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography. Eur Spine J 19(1):96–104

    Article  Google Scholar 

  13. Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22(19):2239–2245

    Article  CAS  PubMed  Google Scholar 

  14. Lehman RA Jr, Lenke LG, Keeler KA et al (2007) Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine 32(24):2679–2684

    Article  PubMed  Google Scholar 

  15. Kuklo TR, Lenke LG, O’Brien MF et al (2005) Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine 30(2):222–226

    Article  PubMed  Google Scholar 

  16. Smorgick Y, Millgram MA, Anekstein Y, et al (2005) Accuracy and safety of thoracic pedicle screw placement in spinal deformities. J Spinal Disord Tech 18(6):522–526

  17. Yingsakmongkol W, Hangsaphuk N, Lerdlam S (2007) The accuracy of pedicle screw placement in thoracic spine using the Funnel technique in idiopathic scoliosis. J Med Assoc Thai 90(1):96–105

    PubMed  Google Scholar 

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Correspondence to Jeremy J. Macke.

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Conflict of interest

Raymund Woo is a consultant for Mazor Robotics and has received $3000 for his time. He has also been reimbursed $1500 for travel. Finally, Dr. Woo has received $10,000 to support other research efforts which does not include this project. Jeremy Macke and Laura Varich declare that they have no conflicts of interest.

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This study did not receive funding.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Macke, J.J., Woo, R. & Varich, L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robotic Surg 10, 145–150 (2016). https://doi.org/10.1007/s11701-016-0587-7

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  • DOI: https://doi.org/10.1007/s11701-016-0587-7

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