292 - The Learning Curve of Robotic Assisted Pedicle Screw Placement in Spin...

#292 The Learning Curve of Robotic Assisted Pedicle Screw Placement in Spine Surgery

Image-Guidance, Navigation, Robotics

Poster Presented by: I.H. Lieberman

Author(s):

X. Hu (1)
I.H. Lieberman (1)

(1) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, USA

Abstract

Introduction: Robotic assisted pedicle screw placement has shown some promising results by increasing the accuracy of spinal instrumentation, reducing potential complications and reducing radiation exposure. However, the learning curve of this new technique has not yet been fully evaluated.

Methods: Data were recorded from technical notes and operative records created immediately following each surgery case in which the robotic system was used to guide pedicle screw placement. All cases were performed at the same hospital by a single surgeon. The majority of patients had spinal deformity and/or previous spine surgery. Each attempted screw placement was classified as:

1) successful placed using the robotic guidance;

2) malpositioned using the robot;

3) robot aborted and screw placed manually;

4) screw omitted and deemed not needed at surgeonĀ“s discretion considering the clinical circumstances.

Results: Ninety patients who successfully underwent robotic assisted pedicle screw placement were classified into three different groups: the first 1 to 30 patients (group 1, median age: 47 years); the 31 to 60 patients (group 2, median age: 52 years); the 61 to 90 patients (group 3, median age: 53 years). Eighty nine percent of the patients had spinal deformity and/or previous spine surgery. The number of attempted pedicle screws was 375 in group 1, 315 in group 2 and 340 in group 3. The rates of successfully placed pedicle screws were 80.00% in group 1, 91.11% in group 2, and 91.47% in group 3 (p>0.05). The rates of malpositioned screws were 0.80% in group1, 0.63% in group 2, and 1.47% in group 3 (p>0.05). The rates of the screws that were converted to manual placement were 17.33% in group 1, 7.94% in group 2, and 5.00% in group 3 (p< 0.01). The rates of the screws that were not placed were 1.87% in group 1, 0.32% in group 2, and 2.06% in group 3 (p< 0.05 between group 2 and 3) (Figure 1).

Conclusion: The rate of the screws that were converted to manual placement decreased dramatically after the first 30 cases. The rate of successfully placed pedicle screws also improved after the first 30 cases but the difference was not statistically significant. From these results it appears that surgeons will achieve consistent results using robotic assited pedicle scre placement after 30 cases especially under deformity and/or revision surgery circumstances.

Figure 1