Clinical and patient-reported outcomes after robot-assisted short-segment lumbar fusion with a minimum 1-year follow-up

Objective: To examine the complications and patient-reported outcomes after robot-assisted short-segment lumbar fusion surgery. Methods: We reviewed a consecutive group of adult patients (≥18 years old) with lumbar degenerative disease who underwent a robot-assisted short lumbar fusion (1-, 2-level) between 2017 and 2019. The minimum follow-up was 1-year. Bivariate and multivariate analyses were performed to determine risk factors for the outcomes. Results: A total of 51 patients underwent a robot-assisted short-segment (1-level: N = 33, 64.7%; 2-level: N = 18, 35.3%) lumbar fusion. The mean age ± standard deviation was 55.4 ± 12.9, and 52.9% of patients were female (N = 27). Intraoperative complications included dural tear (N = 3, 5.9%) and exchange of screws for breach (N = 3, 5.9%). No intraoperative motor/sensory loss was observed in this study sample. The mean length of stay was 2.8 ± 1.6 days. The 1-year readmission and reoperation rates were 11.8% (N = 6) and 7.8% (N = 4), respectively. The reasons for revision surgeries included wound complications requiring irrigation and debridement (N = 3) and disc herniation (N = 1, 2%). Overall, our patients experienced substantial improvements in ODI (MCID%: 6-weeks: 60.1%, 6-month: 78.8%, 1-year: 85.4%, and 2-year: 85.7%). For primary 1-level lumbar fusion, there was a significant reduction of 40 min after the first 20 cases (193 ± 30 min vs. 153 ± 55, p = 0.019). Conclusions: The findings of our study on robot-assisted short-segment lumbar fusions demonstrate that comparable outcomes can be achieved with robotic assistance compared to those reported for both free-hand technique and other robotic systems in current literature. Most patients can expect to achieve substantial improvements in their PROs despite complications. Even after the first 20 cases, surgeons might experience a significant reduction in operative time using this robotic system

Phosphane-catalyzed Knoevenagel condensation: a facile synthesis of α-cyanoacrylates and α-cyanoacrylonitriles

Triphenylphosphane (TPP) has been utilized as a novel and efficient catalyst for the Knoevenagel condensation of aldehydes with acidic methylene compounds such as ethyl cyanoacetate and malononitrile to afford substituted olefins. The reaction proceeds smoothly under mild and solvent-free conditions and the products are obtained in excellent yields with an E-geometry. This method is applicable for a wide range of aldehydes including aromatic, aliphatic and heterocyclic substrates. Microwave irradiation has been used to achieve enhanced reaction rates and improved yields

Does robot-assisted spine surgery for multi-level lumbar fusion achieve better patient-reported outcomes than free-hand techniques?

Objective: To compare the patient-reported outcomes (PROs) between patients undergoing multilevel lumbar fusion with robot-assisted vs. freehand techniques. Methods: This was a single-institution cohort study of adult patients (≥18 years old) undergoing robot-assisted spine surgery from 2016 to 2018 with minimum 2-year follow-up. A propensity-score matching (PSM) algorithm accounted for several perioperative factors. PROs were measured using the Oswestry Disability Index (ODI). The minimum clinically important difference (MCID) between groups were assessed at each follow-up period (6-weeks/6-months/1-year/2-years). Chi-square/fisher exact test and t-test/ANOVA were used for categorical and continuous variables, respectively. Results: After PSM, a total of 70 patients remained. The mean (standard deviation) charlson comorbidity index was 1.4 (1.0) and 57% of patients were female. The most common diagnoses included degenerative disc disease (37.1%), degenerative scoliosis (27.1%), and high grade spondylolisthesis (grade > 2) (19%), and the mean number of instrumented levels was 4.6 (4.4). Rates for intraoperative/postoperative complications, and any reoperation within 2 years after surgery were low and similar between groups. The baseline ODI scores were similar between freehand (39.1) and robot-assisted surgery (40.5, P-value = 0.736). By two years, substantial improvements in both groups (mean ODI-freehand: 4.6, robot-assisted: 1.5; MCID%-freehand: 77.1%, robot-assisted: 82.9%) were achieved, but not significantly different (P-value > 0.05). No differences were observed for the other follow-up periods. When comparing individual component scores, the robot-assisted group scored higher in “Lifting,” “Sitting,” and “Standing;” however, the magnitudes of these differences were less than 1 point. Conclusion: Robot-assisted multi-level lumbar fusion can achieve excellent and similar patient-reported outcomes to conventional freehand techniques. Future studies should include large, prospective randomized controlled trials as well as the inclusion of other patient reported outcome measures

Real-time navigation guidance with intraoperative CT imaging for pedicle screw placement using an augmented reality head-mounted display: a proof-of-concept study.

OBJECTIVE: Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon\u27s field of view, and to assess screw placement accuracy via this method. METHODS: Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2-5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected. RESULTS: Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4% (192 screws). Accuracy for attendings and trainees was 99.1% (112 screws) and 97.5% (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1% vs 94.32%; p = 0.0212) and all users (98.4% vs 94.32%; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100%. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive. CONCLUSIONS: Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience