Robotic-guided Placement of Cervical Pedicle Screws: Feasibility and Accuracy

1. Robotic-guided Placement of Cervical Pedicle Screws: Feasibility and Accuracy Isador H. Lieberman, MD, FRCSC, MBA Xiaobang Hu, PhD

2. ISADOR LIEBERMAN MD MBA FRCSCdisclosures April 2018 AAOS; member CME Courses committee ISASS; member Public Policy committee SMISS; member Board of Directors SRS; member - Annual meeting & IMAST committee Editorial board; Spine, CSS, European Spine J Reviewer; JBJS, Spine Journal,

3. Introduction It has been shown that pedicle screw instrumentation in the cervical spine has superior biomechanical pullout strength and stability. However, due to the complex and variable anatomy of the cervical pedicles and the risk of catastrophic complications, cervical pedicle screw placement is not widely utilized.

4. Purpose • To review and report our experience with robotic guided cervical pedicle screw placement

5. Methods • Retrospective review • Consecutive patients who underwent cervical pedicle screw placement with robotic guidance • Post-operative CT scan available • Single surgeon

6. Methods • Fuse the preoperative CT (with the planned cervical pedicle screws) to the post-op CT. • Compare the planned vs. actual screw placements in both axial and sagittal planes, at the mid-point of the pedicle in a resolution of 0.1 mm. • Medical charts: technical issues and intra-operative complications

7. Methods

8. Results • Four patients (3 female, 1 male) • Mean age: 59 years (range 51-75) • Mean BMI: 23.0 (range 17.7-27.4) • 21 cervical pedicle screws - C2: 4 screws - C3: 2 screws - C4: 4 screws - C5: 3 screws - C6: 4 screws - C7: 4 screws

9. Results • No intra-operative complications related to the placement of cervical pedicle screws • Robotic guidance was successful in all 21 screws • Post-operative CT: 4 pedicle screw breaches

10. Results

19. Conclusion • Our study indicates that robotic guided cervical pedicle screw placement is feasible with clinically acceptable results.

20. Thank You