Miniature robotic guidance for pedicle screw placement in posterior spinal fusion:: early clinical experience with the SpineAssist®

Background Spinal fusion is a commonly performed procedure for a variety of conditions. Pedicle screw fixation has become the standard of care for stabilization of the thoracic and lumbar spine. Precise screw placement is essential to avoid injury to adjacent neural structures. Patients with severe deformity or prior surgery present a challenge to the accurate placement of pedicle screws. Additionally, minimally invasive and percutaneous surgical techniques also present a greater challenge to accurate screw placement and require heavier reliance on intraoperative fluoroscopic imaging, which presents an occupational hazard for the surgeon and the operating-room (OR) staff. The purpose of this paper is to introduce the SpineAssist(R), a miniature robotic guidance system, developed to assist spine surgeons in the accurate placement of pedicle screws. Methods The operative technique is described, as is the experience and results with 14 patients during a 6 month period during which this system was used. Results The SpineAssist(R) performed successfully in 93% of the cases in which it was used. 96% of the screws placed were determined to be within 1 mm of their planned trajectory. Conclusions Difficulties encountered with use of the SpineAssist(R), while minimal, will be described and suggestions made for future improvements. Copyright (C) 2006 John Wiley & Sons, Ltd.