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A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study

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The Journal of Biomedical Research 2019年第3期33卷 208-216页

作者： Kee D.Kim Huy Duong Aditya Muzumdar Mir Hussain Mark Moldavsky Bandon Bucklen Department of Neurological Surgery University of California Davis Department of Neurosurgery Kaiser Permanente medical Group Musculoskeletal Education and Research Center(MERC) Globus Medical Inc

In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.

关键词： lumbosacral fixation sacropelvic fixation sacroiliac screw computer-assisted surgery image-guided surgery

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New spinal robotic technologies

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Frontiers of Medicine 2019年第6期13卷 723-729页

作者： Bowen Jiang Tej DAzad Ethan Cottrill Corinna CZygourakis Alex MZhu Neil Crawford Nicholas Theodore Department of Neurosurgery Johns Hopkins School of MedicineBaltimoreMD 21287USA Department of Neurosurgery Stanford University School of MedicineStanfordCA 94305USA globus medical Inc.AudubonPA 19403USA

Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA,, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly;however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time — issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.

关键词： robotics spine surgery Mazor ExcelsiusGPS ROSA pedicle screw

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Pedicle screw accuracy assessment in ExcelsiusGPS?robotic spine surgery:evaluation of deviation from pre-planned trajectory

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Chinese Neurosurgical Journal 2018年第3期4卷 118-123页

作者： Bowen Jiang A.Karim Ahmed Corinna C.Zygourakis Samuel Kalb Alex M.Zhu Jakub Godzik Camilo A.Molina Ari M.Blitz Ali Bydon Neil Crawford Nicholas Theodore Department of Neurosurgery The Johns Hopkins School of MedicineThe Johns Hopkins Hospital600 N.Wolfe StreetMeyer 7-113BaltimoreMD 21287USA Department of Neurosurgery Barrow Neurological InstituteSt.Joseph’s Hospital and Medical CenterPhoenixAZUSA Department of Neuroradiology Johns Hopkins School of MedicineThe Johns Hopkins Hospital600 N Wolfe StBaltimoreMD 21287USA Department of Neurosurgery Johns Hopkins University School of Medicine1800 Orleans StreetZayed Tower Mailstop 6007Baltimore 21287MDUSA globus medical inc 2560 General Armistead AveAudubon 19403PAUSA

Background: The ExcelsiusGPS?(globus medical, inc., Audubon, PA) is a next-generation spine surgery robotic system recently approved for use in the United States. The objective of the current study is to assess pedicle screw accuracy and clinical outcomes among two of the first operative cases utilizing the ExcelsiusGPS?robotic system and describe a novel metric to quantify screw deviation. Methods: Two patients who underwent lumbar fusion at a single institution with the ExcelsiusGPS?surgical robot were included. Pre-operative trajectory planning was performed from an intra-operative CT scan using the O-arm (Medtronic, inc., Minneapolis, MN). After robotic-assisted screw implantation, a post-operative CT scan was obtained to confirm ideal screw placement and accuracy with the planned trajectory. A novel pedicle screw accuracy algorithm was devised to measure screw tip/tail deviation distance and angular offset on axial and sagittal planes. Screw accuracy was concurrently determined by a blinded neuroradiologist using the traditional Gertzbein-Robbins method. Clinical variables such as symptomatology, operative data, and post-operative follow-up were also collected. Results: Eight pedicle screws were placed in two L4-L5 fusion cases. Mean screw tip deviation was 2.1 mm (range 0.8-5.2 mm), mean tail deviation was 3.2 mm (range 0.9-5.4 mm), and mean angular offset was 2.4 degrees (range 0.7-3.8 degrees). All eight screws were accurately placed based on the Gertzbein-Robbins scale (88% Grade A and 12% Grade B). There were no cases of screw revision or new post-operative deficit. Both patients experienced improvement in Frankel grade and Karnofsky Performance Status (KPS) score by 6 weeks post-op. Conclusion: The ExcelsiusGPS? robot allows for precise execution of an intended pre-planned trajectory and accurate screw placement in the first patients to undergo robotic-assisted fusion with this technology.

关键词： Robotic spine surgery Robot-assisted surgery Excelsius GPS® Gertzbein-Robbins Pedicle screw accuracy

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Complications associated with prone positioning in elective spinal surgery

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World Journal of Orthopedics 2015年第3期6卷 351-359页

作者： J Mason De Passe Mark A Palumbo Maahir Haque Craig P Eberson Alan H Daniels Department of Orthopaedics Warren Alpert Medical School of Brown University

Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient *** many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ *** visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral ***-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal *** nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative *** complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit *** uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been *** of these are well-understood and largely avoidable through thoughtful attention to *** complications,such as POVL,remain incompletely understood and thus more difficult to predict or ***,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.

关键词： Spine Patient positioning Prone position Complications Prevention and control

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