Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study

• Published in: Neurospine 2023-09, Vol.20 (3), p.1028-1039
• Main Authors: Ha, Byeong-Jin, Lee, Jong-Min, Yoon, Seon-Jin, Kim, Byung-Kwan, Lee, Junseok, Lee, Suhun, Ryu, Seungjae, Cha, Yongyeob, Hwang, Sungteac, Woo, Donggi, Lee, Chang Kyu, Shin, Dong Ah, Ha, Yoon, Kuh, Sung Uk, Kim, Keung Nyun, Son, Dongwuk, Yi, Seong
• Format: Article
• Language: English
• Subjects: dimensional measurement accuracy; Original; pedicle screws; robot-assisted spine surgery
• ISSN: 2586-6583; 2586-6591
• DOI: 10.14245/ns.2346552.276

Objective: The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery.Methods: A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS).Results: A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications.Conclusion: Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.