Combined Robotic Navigation System for Screw Placement Shows Efficacy in Spinal Surgery

ISASS19 Meeting Highlight

Peer Reviewed

“Malpositioning of screws in lumbar posterior spinal fusion can lead to neurologic and visceral injury, as well as biomechanical compromise,” Jeffrey A. Goldstein, MD, told attendees at the International Society for the Advancement of Spine Surgery (ISASS) 19th Annual Conference held April 3 to 5, 2019 in Anaheim, CA. “Robotics is very promising in terms of the potential to increase accuracy in pedicle screw placement.” Dr. Goldstein is an orthopaedic spine surgeon at NYU Langone Orthopedic Hospital in New York, NY. He is Chief of the Spine Service for Education and Director of the Spine Fellowship.

pedicle screw implanted into sawboneIn this study, the ExcelsiusGPS® robotic navigation system was considered successful in nearly all spine cases. Photo Source: 123RF.com.

Previous studies of robotics in spine surgery examined a single system, and there are no published studies examining the efficacy of using the ExcelsiusGPS® Robotic Navigation system, which combines robotics with navigation, Dr. Goldstein explained.

To fill this knowledge gap, Dr. Goldstein and colleagues retrospectively examined a case series of consecutive patients (n=106) undergoing thoracolumbar spinal fusion with planned use of the ExcelsiusGPS system.

In all, 636 pedicle screws, 6 iliac screws, and one S2 alar-iliac screw were placed using the ExcelsiusGPS robotic system. A total of 88 screw placements were planned using preoperative computed tomography (CT), and 13 cases included intraoperative fluoroscopy.

High Success Rate Found With the ExcelsiusGPS System

Robotic pedicle screw placement with Globus Medical’s ExcelsiusGPS robotic system was considered successful in nearly all cases (99%). Five pedicle screw placements in 2 patients were aborted prior to pedicle placement.

A planned subgroup analysis of the patients (n=13) with postoperative CT scans showed that 62 of the 66 screw placements with the robotic system were graded as “A” on the Gertzbein and Robbins system, indicating there was no screw perforation outside of the pedicle. The remaining 4 screw placements were graded “B”, indicating that the screw perforated <2 mm outside of the pedicle.

“We considered grades A and B to be acceptable,” Dr. Goldstein explained. “The bottom line is that we had no screw-related complications, and no patients required revision for screw placement.”

About the ExcelsiusGPS Robotic System

The combined robotic navigation system provides the opportunity to plan screw placement in three planes preoperatively. The system allows for preoperative CT, intraoperative CT, or intraoperative x-rays.

“This is not like a da Vinci surgical system where the robot touches the patient,” Dr. Goldstein explained. “The Globus ExcelsiusGPS system actually never touches the patient. It gives you an opportunity to get tactile feedback as you put the screw into bone, as the robot guides you.”

Single position lateral and posterior fusion surgery increases OR efficiency. “Intraoperatively during pedicle screw placement, after completion of the lateral lumbar interbody fusion portion, the table is tilted ventrally,” Dr. Goldstein explained. “The placement of the dynamic reference base, registration fluoroscopy, and screw drilling, tapping, and placement all proceed as in the prone position. The robot is brought in from the patient’s dorsal side. Thus, the system saves you a lot of time in repositioning and re-draping when performed in a single position,” Dr. Goldstein said.

Conclusion

“The Globus robot is a novel technology that could be used to accurately place screws through a variety of spinal procedures, notably in this series, after interbody technique,” Dr. Goldstein concluded. “In addition, the system shows the potential to reduce screw-related complications.”

Disclosure
Dr. Goldstein is consultant for Globus Medical.

Updated on: 06/12/19
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Jeffrey A. Goldstein, MD, FACS
Orthopaedic Spine Surgeon
NYU Langone Medical Center Hospital for Joint Diseases
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