Robotic vs. Fluoroscopic Guidance in Spine Surgery: 5 Key Findings



An article recently published in the Journal of Neurosurgery: Spine examined the safety and accuracy of robot-assisted pedicle screw insertion.



The researchers examined data for 95 patients with degenerative disease who underwent elective lumbar instrumentation. There were 55 patients who underwent surgery with robotic assistance, inserting 244 screws. There were 40 patients who underwent fluoroscopy-guided surgery, placing 163 screws using anatomical landmarks.


Here are five findings from the study:


1. A perfect trajectory was observed in 83.6 percent of the robotically-placed screws. Among the patients who underwent fluoroscopy-guided pedicle screw insertion, a perfect trajectory was observed in 79.8 percent of the patients.


There are studies showing the clinical advantages of robotics in spine surgery, but what about cost-effectiveness? As part of a panel on robotics presented at the 2013 North American Spine Society Annual Meeting, the presenters mentioned no studies existed on the cost-effectiveness robotic guidance in spine surgery, but among image-guided procedures the revision rate at one institution was reduced from 3 percent to 0 percent at a cost-savings of $71,286 on the first 100 cases.


2. The robotic-guided screws that were not perfectly placed were graded "B," "C," "D," "E," and "R" — meaning "revised." Both "A" and "B" group categories were considered clinically acceptable. The percentage of screws in each grade category were:


•    B: 7.8 percent
•    C: 3.7 percent
•    D: 1.6 percent
•    E: 0.8 percent
•    R: 2.5 percent


3. The fluoroscopy-assisted screw insertions that were not graded the perfect "A" were also categorized by the subsequent letter groupings. The percentage of screws in each category were:


•    B: 7.4 percent
•    C: 6.1 percent
•    D: 3.7 percent
•    E: 3.1 percent


The clinically acceptable screws were not different between the groups or subgroups.


4. There was less blood loss in the robotic-assisted group than the fluoroscopy-guided group. A study published earlier this year in Spine also found robotic guidance lowers radiation exposure 74 percent when compared with fluoroscopy during vertebral body augmentation.


The researchers in that study measured average operative radiation time was 46.1 seconds per level with average surgeon and staff exposure time per augmented level at 37.6 seconds. The procedure took 36 minutes on average with robotic guidance and had a 99 percent accuracy rate.


5. There was no difference in length of stay, surgery duration and cumulative morphine dose between the two groups. The authors concluded, "Robotic-guided pedicle screw placement is a safe and useful tool for assisting spine surgeons in degenerative spine cases. Nonetheless, technical difficulties remain and fluoroscopy backup is advocated."


Robotics isn't just a trend in spine; there are several specialties where robotics is developing. The global medical robotic systems market is expected to reach $3.8 billion in 2018, according to MarketsandMarkets. It was valued at $1.8 billion in 2013.


More Articles on Spine Surgery:
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