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An HSS examine examined the effectiveness of robot-assisted and augmented actuality surgical procedures. | Supply: Adobe Inventory
A examine on the Hospital for Particular Surgical procedure, or HSS, evaluating robot-assisted navigation to using augmented actuality in spinal surgical procedure discovered that each methods exhibit glorious accuracy and security for pedicle screw placement.
Greater than 1.2 million spinal surgical procedures are carried out within the U.S. annually, based on the Nationwide Middle for Well being Statistics. Many of those procedures contain implants referred to as pedicle screws to stabilize the backbone, and exact positioning is crucial for a profitable surgical procedure.
“In comparison with standard free-hand methods, each robotic-assisted navigation [RAN] and using augmented actuality [AR] have demonstrated superior accuracy,” stated Darren R. Lebl, M.D., MBA. “Our examine is the primary to immediately evaluate RAN to AR with respect to screw placement precision.”
Lebl is a backbone surgeon and director of analysis at HSS, plus principal investigator of the examine. The analysis was printed on-line within the journal Backbone.
HSS is a number one tutorial medical middle targeted on musculoskeletal well being. Based in 1863, the New York-based healthcare supplier claimed it has the bottom readmission charges within the nation for orthopedics, in addition to a number of the lowest an infection and complication charges.
Along with affected person care, HSS stated it helps analysis, innovation, and schooling. The HSS Analysis Institute contains 20 laboratories and 300 employees members targeted on advancing musculoskeletal well being by means of the prevention of degeneration, tissue restore, and tissue regeneration.
Darren R. Lebl is a backbone surgeon and director of analysis at HSS. | Supply: Hospital for Particular Surgical procedure
Robotic-assisted surgical procedure and AR supply support
Over the previous decade, quite a few robot-assisted navigation and augmented actuality methods have emerged for backbone surgical procedure.
“Along with enhanced accuracy, the potential benefits of each applied sciences embody lowered radiation publicity and supply for improved security in backbone surgical procedure,” famous Dr. Lebl. “A rising variety of main medical facilities nationwide are utilizing a minimum of one among these applied sciences.”
RAN entails robotic steering of surgeon-operated devices. A robotic arm, together with 3D photos of the affected person’s anatomy and navigation expertise much like GPS, permits the surgeon to carry out a minimally invasive process that’s deliberate forward of time on superior software program.
AR-assisted backbone surgical procedure superimposes 3D photos of a affected person’s anatomy onto the surgeon’s visible subject throughout surgical procedure by way of a headset. A preoperative CT scan of the affected person’s backbone is used to plan and carry out the surgical procedure.
Examine analyzes spinal surgical procedures
The HSS examine included 212 grownup backbone surgical procedure sufferers who had a complete of 1,211 pedicle screws positioned between June 2020 and October 2023. It adopted 108 individuals who acquired 827 screws utilizing robots and 104 sufferers who acquired 384 screws with augmented actuality.
They underwent surgical procedure within the lumbar and/or sacral backbone for degenerative spinal circumstances. One skilled surgeon carried out all the robotic circumstances, whereas two different skilled backbone surgeons used the AR system.
The place of every pedicle screw was assessed after surgical procedure based mostly on both CT scan or 3D fluoroscopy utilizing the Gertzbein-Robbins classification system, which assigns a grade of A, B, C or D to judge accuracy. The HSS researchers thought of Grades A and B to be acceptable.
The A score is assigned to screw placement fully inside the pedicle, a bony construction on the vertebra that protects the spinal twine. Grade B, nonetheless acceptable, is assigned to a screw that’s 2mm (1/16 inch) exterior of the specified location. Within the examine, any screw with a Grade C or D can be deemed unacceptable.
After surgical procedure, two impartial backbone surgeons assigned a grade to all of the pedicle screws. The examine discovered no vital distinction between robot-assisted and AR screw placement when it comes to accuracy, with 99.6% of RAN screws rated as Grade A or B, and 98.7% of AR screws labeled as A or B. General, 92.6% of the screws achieved the highest Grade A score.
“Our outcomes confirmed glorious accuracy for each methods, making each robotics and AR secure instruments for correct positioning of lumbosacral pedicle screws,” Dr. Lebl stated. “Nevertheless, the next price of Grade A screws was seen within the RAN group, probably highlighting superior precision for robotics.”
