Assessing the Intraoperative Accuracy of Pedicle Screw Placement by Using a Bone-Mounted Miniature Robot System through Secondary Registration

<div><p>Introduction</p><p>Pedicle screws are commonly employed to restore spinal stability and correct deformities. The Renaissance robotic system was developed to improve the accuracy of pedicle screw placement.</p><p>Purpose</p><p>In this study, we developed an intraoperative classification system for evaluating the accuracy of pedicle screw placements through secondary registration. Furthermore, we evaluated the benefits of using the Renaissance robotic system in pedicle screw placement and postoperative evaluations. Finally, we examined the factors affecting the accuracy of pedicle screw implantation.</p><p>Results</p><p>Through use of the Renaissance robotic system, the accuracy of Kirschner-wire (K-wire) placements deviating <3 mm from the planned trajectory was determined to be 98.74%. According to our classification system, the robot-guided pedicle screw implantation attained an accuracy of 94.00% before repositioning and 98.74% after repositioning. However, the malposition rate before repositioning was 5.99%; among these placements, 4.73% were immediately repositioned using the robot system and 1.26% were manually repositioned after a failed robot repositioning attempt. Most K-wire entry points deviated caudally and laterally.</p><p>Conclusion</p><p>The Renaissance robotic system offers high accuracy in pedicle screw placement. Secondary registration improves the accuracy through increasing the precision of the positioning; moreover, intraoperative evaluation enables immediate repositioning. Furthermore, the K-wire tends to deviate caudally and laterally from the entry point because of skiving, which is characteristic of robot-assisted pedicle screw placement.</p></div

Assessing the Intraoperative Accuracy of Pedicle Screw Placement by Using a Bone-Mounted Miniature Robot System through Secondary Registration - Fig 2

<p><b>Classification system for assessing intraoperative accuracy</b> Fig 2A depicts type I classification, Fig 2B and 2C depict type II classifications, and Fig 2D depicts Type III calssification. (green line: planned trajectory; white line: implanted K-wire).</p

Incidence and hazard ratios of osteoporosis by demographic characteristics and comorbidity among patients with or without atopic dermatitis.

<p>Incidence and hazard ratios of osteoporosis by demographic characteristics and comorbidity among patients with or without atopic dermatitis.</p

K-wire placement under the assistance of the robot before and after reregistration.

<p>A patient with lumbar spondylolisthesis received instrumentation from L3 to L5, and malpositioned bilateral L3 K-wires were noted initially. Fig 4A and 4B depict both left and right K-wire malpositions (Classification III) from the planned trajectory, as shown in the anteroposterior view (Fig 4A) and oblique view (Fig 4B). Fig 4C and 4D depict improved accuracy from classification type III to type I after the reregistration and adjustment of the K-wire placement.(Black arrow: planned trajectory; white star: implanted K-wire; green line: planned trajectory)</p

Risk factor analysis of osteoporosis in patients with atopic dermatitis.

<p>Risk factor analysis of osteoporosis in patients with atopic dermatitis.</p

Process of the secondary registration and repositioning of the K-wire

<p>Process of the secondary registration and repositioning of the K-wire</p

Baseline characteristics of patients with and without atopic dermatitis in Taiwan.

<p>Baseline characteristics of patients with and without atopic dermatitis in Taiwan.</p

Entry point of the K-wire.

<p>Preoperative planned entry point is the center of the circle. Most K-wire entry points deviated caudally and laterally.</p

Flow diagram of the present study from the National Health Insurance Research Database in Taiwan.

<p>LHID = Longitudinal Health Insurance Database.</p

Incidence of hip fracture at different age stratification and different follow-up duration among patients with or without erectile dysfunction.

<p>Incidence of hip fracture at different age stratification and different follow-up duration among patients with or without erectile dysfunction.</p