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PurposeRobotic assistance in spine surgery is emerging as an accurate, effective and enabling technology utilized in the treatment of patients with surgical spinal pathology. Robotic systems have a wide range of applications in spine surgery from the planning and execution of spinal instrumentation to intra-operative navigation. The safety and reproducibility of robotic assistance in the placement of pedicle screw instrumentation is still being investigated, and here we present our experience of instrumented spinal fusion utilizing an intra-operative robotic guidance system. Patients and methodsWe retrospectively reviewed all cases of spinal instrumentation of the thoracic and lumbo-sacral spine using the Mazor X robotic system (Medtronic Inc, USA), performed at our institution by one surgeon between July 2017 and June 2020. Clinical variables in addition to operative details and complications were recorded. To replicate clinical relevance, screw accuracy was assessed on postoperative antero-posterior and lateral x-rays by two independent neurosurgeons. Wilcoxon Rank test was used to compare time taken to place each screw during the first 20 cases and the cases thereafter.ResultsA total of 28 patients were included. A total of 159 screws were placed using the Mazor X robotic system. The overall mean time for screw placement was 7.8 ± 2.3 minutes and there was a significant reduction in the mean time for screw placement after the 20th case (8.70 min vs. 5.42 minutes, p=0.008). Mean follow-up was 13.0 ± 12.9 months. No post-operative neurologic deficit or new radiculopathy was noted to occur secondary to hardware placement. No revision surgery was required for replacement or removal of a mispositioned screw. No post-operative hardware complications such as hardware migration, or failure were noted within the follow-up period. ConclusionsFrom this single-center, single-surgeon series we conclude that robot-assisted spine surgery can be safely and efficiently integrated into the operating room workflow, which improves after a learning curve of approximately 20 operative interventions. We found robot-assisted spinal instrumentation to be reliable, safe, effective and highly precise. |
