Anatomical and Technical Considerations of Robot-Assisted Cervical Pedicle Screw Placement: A Cadaveric Study

Jennifer Z. Mao, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Mohamed A. Soliman, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Brian A. Karamian, Department of Orthopaedic Surgery, 387400Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA.
Asham Khan, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Alexander G. Fritz, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Naval Avasthi, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Stephen DiMaria, Department of Orthopaedic Surgery, 387400Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA.
Bennett R. Levy, George Washington University, 50430School of Medicine and Health Sciences, Washington DC, USA.
Timothy E. O'Connor, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Gregory Schroeder, Department of Orthopaedic Surgery, 387400Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA.
John Pollina, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.
Alexander R. Vaccaro, Department of Orthopaedic Surgery, 387400Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA.
Jeffrey P. Mullin, Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA.

Document Type

Journal Article

Publication Date

2-23-2022

Journal

Global spine journal

DOI

10.1177/21925682211068410

Keywords

anatomical; cadaver; cervical pedicle screw; robot-assisted; technical

Abstract

STUDY DESIGN: Cadaver study. OBJECTIVES: Assess the feasibility of robot-assisted cervical pedicle screw (RA-CPS) placement and understand the anatomical considerations of this technique. METHODS: Four cadaver specimens free from bony pathology were acquired. Anatomical considerations, such as pedicle width (PW) and height (PH), transverse pedicle angle (TPA), and maximal screw length (MSL), were recorded from preoperative computational tomography (CT) scans. Intraoperative cone-beam CT was acquired and registered to the robotic system. After cervical levels were segmented, screw sizes and trajectories were planned, and RA-CPS were placed. Accuracy was assessed using Gertzbein and Robbin's classification on postoperative CT scans. RESULTS: Thirty-five RA-CPS were placed. Major breaches (≥Grade C) occurred in 28.57% screws. Grade A or B accuracy was found in 71.43% of screws, with the most common direction of breach being medial (81.3%). The greatest proportion of breach per level occurred in the upper subaxial levels, (C3:71.4%, C4 66.6%, C5:50%) which had the smallest PW (C3: 4.34 ± .96 mm, C4: 4.48 ± .60, C5: 5.76 ± 1.11). PH was greatest at C2 (8.14 ± 1.89 mm) and ranged subaxial from 6.36 mm (C3) to 7.48 mm (C7). The mean PW was 5.37 mm and increased caudally from 4.34 mm (C3) to 6.31 mm (C7). The mean TPA was 39.9° and decreased moving caudally 46.9°) to C7 (34.4°). The MSL was 37.1 mm and increased from C2 (26.3 mm) to C7 (41.0 mm). CONCLUSION: RA-CPS has the potential to be feasible, but technological and instrument modifications are necessary to increase the accuracy in the cervical region.

Department

Nursing Student Publications

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