Pedicle screw placement accuracy of bone-mounted miniature robot system

Abstract

This article describes factors affecting the accuracy of transpedicle screw placements performed with the Renaissance robot-guided system and reviews the relevant literature. Between January 2013 and January 2015, Renaissance robot-guided spinal surgery was performed in 125 patients at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. The surgeries included 662 transpedicle screw implants and 49 Kirschner wire (K-wire) reimplants performed by intraoperative repositioning. The lead author evaluated the accuracy of all K-wire insertions and classified their accuracy into 3 categories relative to the preoperative plan for transpedicle screw placement. For cases in which screws required repositioning after the registration step, factors affecting pedicle screw placement were determined according to the consensus of 3 experienced spinal surgeons. According to the scheme developed by Kuo et al (PLoS One 2016; 11:e0153235), the K-wire placement accuracies before and after repositioning were respectively classified as follows: 76.1% and 77.6% in type I; 12.2% and 17.7% in type IIa; 4.3% and 4.5% in type IIb; 6.4% and 0% in type IIIa; and 1% and 1% in type IIIb. The percentage of screws requiring repositioning due to drilling error was 85.7% (42/49). Comparisons of preoperative and postoperative function showed significantly improved accuracy. This study showed that inaccurate pedicle screw placement mainly results from errors in preoperative planning, mounting, registration, drilling, and robot assembly. Pedicle screw placement using a bone-mounted miniature robot system requires meticulous preoperative planning to minimize these errors. Abbreviations: CT = computed tomography, K-wire = Kirschner wire, ODI = Oswestry disability index, VAS = visual analog scale.