Robotic Assisted Percutaneous Pedicle Screw Fixation for Thoracolumbar Spine Fractures

Scientific background: Percutaneous fluoroscopy assisted pedicle screw fixation for thoracolumbar spine fractures is associated with preservation of posterior musculature, less blood loss, shorter operative time, lower infection risk, less postoperative pain, when compared to open surgery, but with increased radiation exposure for the surgical team and patients. Robotic assisted spine surgery is an emerging field of surgery that has been shown to reduce radiation exposure with high level of safety. The purpose of this study is to evaluate the outcome of robotic assisted percutaneous pedicle screw fixation for thoracolumbar spine fractures.

Methods: A ambispective review of all patients with thoracolumbar fractures who were managed with robotic assisted percutaneous transpedicular screw fixation(Renaissance, Mazor robotics, Israel) at our medical center between November 2009 and July 2016. Demographic data, accuracy rates, post operative alignment, radiation exposure were evaluated.

Results: Twenty two patients underwent robotic assisted percutaneous screw fixation between 11/2009 and 7/2016 for thoracolumbar fractures. The average age was 41.1 years (range 17-82). Twelve cases were due to falls from height, 3 for MVA, 3 extension type injuries , and four from other mechanisims.

Three of the patients were poly trauma patients. 154 screws were placed in total. Levels operated ranged from 3-7 levels. In three cases cemented fenestrated screws were used. Mean total case radiation time per screw was 4.1 seconds. Only one screw was removed and inserted again manually (0.65%) because of malplacement. There were no treatment-related complications. There were no revision surgeries.

Discussion: Robotic assisted percutaneous pedicle screw fixation for thoracolumbar spine fractures is a safe method for screw placement for thoracolumbar trauma cases. It allows restoration of the sagittal alignment with satisfactory clinical results even for geriatric patients and poly trauma patients with reduced radiation to the patient and surgeon when compared to free hand techniques . The non fusion screw fixation allows removal of the screws if needed after healing has set. A comperative study with other navigation techniques is needed.