Accuracy of Pedicle Screw Placement Using the ExcelsiusGPS Robotic Navigation Platform: An Analysis of 728 Screws.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-11-26 DOI:10.14444/8660

Meghana Bhimreddy, Andrew M Hersh, Kelly Jiang, Carly Weber-Levine, A Daniel Davidar, Arjun K Menta, Brendan F Judy, Daniel Lubelski, Ali Bydon, Jon Weingart, Nicholas Theodore

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Abstract

Background: Robotic platforms have increased in sophistication for pedicle screw placement. Here, we review our institutional experience using ExcelsiusGPS to assess the accuracy rate of pedicle screw placement throughout the spine and characterize predictors of placement inaccuracy.

Study design: Retrospective cohort study.

Methods: Patients from 2017 to 2022 undergoing spinal fusion surgery with ExelsiusGPS-assisted screw implantation at a single tertiary center were retrospectively identified. Patient demographics, preoperative symptoms, and operative details were collected. Postoperative computed tomography was used to classify screw placement accuracy according to the Gertzbein and Robbins scale (GRS). A stepwise multivariable ordered logistic regression analysis determined independent risk factors for clinically inaccurate screws (GRS C/D/E).

Results: One hundred and seventeen patients were included. Mean age was 60.6 ± 13.2 years, with 57% men, 72% white, and mean body mass index of 29.9 ± 6.4 kg/m². Seven hundred and twenty-eight screws were placed, predominantly in the thoracic (29.5%) and lumbar (52.6%) regions. Accuracy classification indicated 670 GRS A, 31 GRS B, 22 GRS C, 4 GRS D, and 1 GRS E screws. The clinically acceptable screw placement rate (GRS A/B) was 96%. Male gender (odds ratio [OR]: 2.12, P = 0.03), revision surgery (OR: 2.43, P = 0.02), and thoracic level screw insertion (OR: 2.33, P = 0.01) were independently associated with inaccurate screw placement and explained 8.7% of the variability seen. Of the 728 screws placed, 3 required revision after postoperative imaging revealed loosening or pedicle breach.

Conclusion: ExcelsiusGPS-assisted screw insertion has high placement accuracy and low revision rates. Identification of predictors of inaccuracy illustrates that similar variables, such as placement in the thoracic spine and revision surgery status, apply to both freehand and robotic screw placement.

Clinical relevance: Robotic spine surgery is an accurate, reliable tool that can improve patient outcomes. Factors like male gender, thoracic screw placement, and revision surgery status are associated with lower screw placement accuracy, and these factors should inform surgical decision-making when using robotic assistance.

Level of evidence: 4:

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使用ExcelsiusGPS机器人导航平台进行椎弓根螺钉置放的准确性：对728枚螺钉的分析

背景：用于椎弓根螺钉置入的机器人平台越来越先进。在此，我们回顾了本机构使用ExcelsiusGPS评估整个脊柱椎弓根螺钉置入准确率的经验，并分析了置入不准确的预测因素：回顾性队列研究：回顾性识别2017年至2022年在一家三级中心接受ExelsiusGPS辅助螺钉植入脊柱融合手术的患者。收集了患者的人口统计学资料、术前症状和手术细节。术后计算机断层扫描根据 Gertzbein 和 Robbins 量表（GRS）对螺钉植入的准确性进行了分类。逐步多变量有序逻辑回归分析确定了临床螺钉放置不准确（GRS C/D/E）的独立风险因素：结果：共纳入 177 名患者。平均年龄为 60.6 ± 13.2 岁，男性占 57%，白人占 72%，平均体重指数为 29.9 ± 6.4 kg/m2。共放置了 728 枚螺钉，主要集中在胸椎（29.5%）和腰椎（52.6%）部位。精确度分类显示，670 枚螺钉为 GRS A 型，31 枚为 GRS B 型，22 枚为 GRS C 型，4 枚为 GRS D 型，1 枚为 GRS E 型。临床可接受的螺钉置放率（GRS A/B）为 96%。男性性别（几率比 [OR]：2.12，P = 0.03）、翻修手术（OR：2.43，P = 0.02）和胸椎水平螺钉植入（OR：2.33，P = 0.01）与螺钉置入不准确独立相关，占所见变异的 8.7%。在放置的728枚螺钉中，有3枚在术后成像发现松动或椎弓根破损后需要进行翻修：结论：ExcelsiusGPS辅助螺钉置入术具有较高的置入准确性和较低的翻修率。结论：ExcelsiusGPS辅助螺钉植入准确率高，翻修率低。对不准确性预测因素的识别表明，类似的变量，如在胸椎的植入和翻修手术状态，适用于徒手和机器人螺钉植入：机器人脊柱手术是一种精确、可靠的工具，可以改善患者的预后。男性性别、胸椎螺钉置放位置和翻修手术状态等因素与较低的螺钉置放准确性有关，在使用机器人辅助时，这些因素应作为手术决策的参考：4:

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.