Robotic-Assisted Vertebroplasty
- SpineVidya
- Dec 3, 2024
- 2 min read
Updated: Jan 10
Introduction to Vertebroplasty and Cement Augmented Screws
Robotic systems extend their utility beyond the placement of thoracolumbar screws. They also enable precise drilling trajectories for working channel insertion in kyphoplasty and vertebroplasty, enhancing surgical outcomes and precision.
Pin-less Robot-Assisted Vertebro/Kyphoplasty
Initial Steps:
The work volume is defined using "3Define," and robot navigation registration is performed with a snapshot. A blunt passive planar probe marks the target vertebrae, ensuring accurate placement without physical mounting of the robot to the patient. Minimal force is applied during drilling, allowing the robot arm to target cranial vertebrae effectively.
Image Utilization:
O-arm images are transferred to the robotic system, and the region of interest is marked and segmented. This facilitates accurate planning and execution, even in complex cases.
Challenges and Planning:
Postural reduction of fractures can complicate level labeling. Trajectories are meticulously planned to avoid facet joint violations, with robot assistance ensuring precise direction to the superior and inferior endplates.
Directing the Trajectory to Fracture Site
Advantages of Robot Assistance:
Robots provide precise trajectories to fracture sites, allowing for accurate guidewire placement on the first attempt. This minimizes the need for multiple entry points and reduces complications.
Special Considerations:
Robotic assistance is especially advantageous in cases involving deformities or obesity, where pedicle visualization under fluoroscopy can be challenging.
Placing Trocar & Guidewires
Percutaneous incisions are made, and the sleeve and dilator are docked to the bone. Using a 3 × 30 mm feather-touch drill, trajectories are created, and guidewires are placed. These guidewires enable the precise placement of working trocars.
Kyphoplasty/Vertebroplasty Execution:
Working channels are placed over guidewires under fluoroscopic guidance. Balloons are inserted into the vertebrae and inflated until they meet at the midline in the AP view. Afterward, the balloons are deflated, and bone cement is gradually injected into the cavity using fillers and plungers.
Cement Augmented Screws
Cement-augmented screws are used for the stabilization of osteoporotic vertebrae. The procedure utilizes similar working channels as kyphoplasty. Cement is injected into the bone using fillers, and the robotic arm directs the screw trajectory. Screws are inserted to the appropriate depth using power tools.
Key Considerations:
Once the cement sets, advancing or withdrawing screws is not possible, making precise initial placement critical.
Sacroplasty
Patient Case:
A 56-year-old woman with persistent lower back pain, but no history of trauma, was diagnosed with sacral insufficiency fractures and edema, confirmed by MRI after six weeks.
Treatment Plan:
Short-axis trajectories were planned, and 9 mL of bone cement was injected into the sacrum. The patient was mobilized pain-free within two hours post-procedure.
Publications:
Cement augmentation has been successfully performed on 102 vertebrae across 84 patients. The novel percutaneous double-balloon kyphoplasty technique was published in the Indian Spine Journal, showcasing its effectiveness and innovative approach.
This guide demonstrates the significant advancements robotic systems bring to vertebroplasty, offering precise, minimally invasive solutions to complex spinal conditions.
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