Skip to main content
SpringerLink
Log in

Ensuring navigation integrity using robotics in spine surgery

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

There are potential pitfalls associated with the pursuit of accurate surgical navigation, such as vulnerability of the reference array to accidental dislodgment and damage or soiling of tracking arrays on tools. Additionally, there are hazards encountered when attempting accurate robotic screw placement in spine surgery, including skiving of the tool on bone, displacement of the robotic arm, or patient movement. Proven techniques are needed to address and mitigate these issues to ensure that navigation integrity is maintained and screw placement is accurate when using navigated robotic surgical guidance systems. The following research describes some potential hazards commonly encountered in robotic navigated screw placement, suggests techniques for overcoming these hazards, and provides examples of how these techniques have been incorporated into existing surgical robotic guidance systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hyun SJ, Kim KJ, Jahng TA et al (2017) Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976) 42:353–358

    Article  Google Scholar 

  2. Kantelhardt SR, Martinez R, Baerwinkel S et al (2011) Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 20:860–868

    Article  Google Scholar 

  3. Laudato PA, Pierzchala K, Schizas C (2018) Pedicle screw insertion accuracy using O-arm, robotic guidance, or freehand technique: a comparative study. Spine (Phila Pa 1976) 43:E373–E378

    Article  Google Scholar 

  4. Lonjon N, Chan-Seng E, Costalat V et al (2016) Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J 25:947–955

    Article  Google Scholar 

  5. Molliqaj G, Schatlo B, Alaid A et al (2017) Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus 42:E14

    Article  Google Scholar 

  6. Ringel F, Stuer C, Reinke A et al (2012) Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976) 37:E496–E501

    Article  Google Scholar 

  7. Villard J, Ryang YM, Demetriades AK et al (2014) Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976) 39:1004–1009

    Article  Google Scholar 

  8. Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, Pichelmann MA (2014) Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance. Neurosurg Focus 36:E3

    Article  Google Scholar 

  9. Houten JK, Nasser R, Baxi N (2012) clinical assessment of percutaneous lumbar pedicle screw placement using the O-Arm multidimensional surgical imaging system. Neurosurgery 70:990–995

    Article  Google Scholar 

  10. Holly LT, Foley KT (2003) Intraoperative spinal navigation. Spine (Phila Pa 1976) 28:S54–S61

    Google Scholar 

  11. Crawford NR, Major C, Bartelme M, Johnson N, Cicchini S (2016) Surgical tool systems and methods. US Patent Publication No. US 2016/0278875 A1, Sept. 29, 2016

  12. Takahashi J, Hirabayashi H, Hashidate H, Ogihara N, Kato H (2010) Accuracy of multilevel registration in image-guided pedicle screw insertion for adolescent idiopathic scoliosis. Spine (Phila, Pa 1976) 35:347–352

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Globus Medical, Inc., 300 Griffin Brook Drive, Methuen, MA, USA

    Neil Crawford & Norbert Johnson

  2. Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, USA

    Nicholas Theodore

Authors
  1. Neil Crawford
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norbert Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas Theodore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neil Crawford.

Ethics declarations

Conflict of interest

The Excelsius GPS™ robot described in this manuscript manufactured by Globus Medical, Inc. (GMI) was invented by authors Neil Crawford, PhD, and Nicholas Theodore, MD. Author Neil Crawford, PhD, is entitled to royalty payments on sales of the Excelsius GPS™ robot and owns GMI stock. Author Nicholas Theodore, MD, is entitled to royalty payments on sales of the Excelsius GPS™ robot and owns GMI stock. Author Nicholas Theodore, MD, is a paid consultant to GMI. Author Neil Crawford, PhD, is a salaried employee of GMI. Author Norbert Johnson, MS, is a salaried employee of GMI.

Human rights and participants

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crawford, N., Johnson, N. & Theodore, N. Ensuring navigation integrity using robotics in spine surgery. J Robotic Surg 14, 177–183 (2020). https://doi.org/10.1007/s11701-019-00963-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-019-00963-w

Keywords

Search

Navigation