Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution.

Background: In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation.

Methods: A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion.

Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging.

Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery.

In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed.

Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution.

Proper pedicle screw placement is an integral part of spine fusion requiring expertly trained spine surgeons. Advances in medical imaging guidance have improved accuracy. There is high interest in the emerging field of robot-assisted spine surgery; however, safety and accuracy studies are needed.

Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee.

Study Design: Structured literature review.

Objectives: The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding.

Summary Of Background Data: Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed.

Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee.

Background: Spondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.

Methods: Literature was searched professionally and citations retrieved.

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance.

Background: Technological advances, including navigation, have been made to improve safety and accuracy of pedicle screw fixation. We evaluated the accuracy of the virtual screw placement (Stealth projection) compared to actual screw placement (intra-operative O-Arm) and examined for differences based on the distance from the reference frame.

Methods: A retrospective evaluation of prospectively collected data was conducted from January 2013 to September 2013.

Sacral bone mineral density (BMD) assessment using opportunistic CT scans.

This study seeks to establish a method for opportunistic evaluation of sacral bone mineral density. This is a retrospective review of 109 scans from 109 patients who had renal-protocol computed tomography (CT) scans performed for any indication during a 3-month period at a single academic institution in 2014. In the collected CT scans, sacral CT-attenuation in multiple regions of interest (ROI) was compared to the L1 CT-attenuation, an internal reference standard, to determine if a correlation existed.

Pulmonary function tests correlated with thoracic volumes in adolescent idiopathic scoliosis.

Scoliosis deformity has been linked with deleterious changes in the thoracic cavity that affect pulmonary function. The causal relationship between spinal deformity and pulmonary function has yet to be fully defined. It has been hypothesized that deformity correction improves pulmonary function by restoring both respiratory muscle efficiency and increasing the space available to the lungs.

Which Malpositioned Pedicle Screws Should Be Revised?

Background: Up to 10% of free-hand pedicle screws are malpositioned, and 1 in 300 patients may undergo return to surgery for revision of malpositioned screws. The indications for revision of asymptomatic malpositioned screws have not been carefully examined in the literature. We sought to evaluate the threshold among spinal deformity surgeons for revision of malpositioned screws.

Accuracy of Pedicle Screw Placement in Children 10 Years or Younger Using Navigation and Intraoperative CT.

Study Design: A consecutive case series.

Objective: To determine the revision rate for pedicle screws placed using intraoperative CT and image-guided navigation in children 10 years or younger.

Summary Of Background Data: Screws are frequently used for spinal instrumentation in young children, although this is only by physician-directed use.

How Much Work Effort is Involved in Minimally Invasive Sacroiliac Joint Fusion?

Background: Minimally invasive sacroiliac joint fusion is increasing significantly. Starting January 1, 2015, it has a category I CPT code. The current RVU for this procedure is not equal to the amount of work involved.

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Objective: There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.

Methods: Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids' Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database.

Comparison of nonnavigated and 3-dimensional image-based computer navigated balloon kyphoplasty.

Balloon kyphoplasty is a common treatment for osteoporotic and pathologic compression fractures. Advantages include minimal tissue disruption, quick recovery, pain relief, and in some cases prevention of progressive sagittal deformity. The benefit of image-based navigation in kyphoplasty has not been established.

Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee.

Study Design: Structured literature review.

Objectives: The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding.

Summary Of Background Data: Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed.

Current Evidence Regarding the Etiology, Prevalence, Natural History, and Prognosis of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee.

Study Design: Structured literature review.

Objectives: To assess the current state of evidence as a first step in the development of practice guidelines for pediatric spondylolysis.

Summary Of Background Data: Progress in published medical knowledge, changes in societal expectations, and developments in health care economics have led medical organizations to develop evidence-based documents and products.

Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion.

Background: The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment.

Reprocessed arthroscopic shavers: evaluation of sharpness and function in a cadaver model.

This study was designed to test limited arthroscopic shaver reuse following reprocessing and to compare the functional performance between new and reprocessed arthroscopic shavers in arthroscopic procedures using fresh cadaveric knees. A trial using arthroscopic procedures (menisectomy, synovectomy, and debridements) was conducted by experienced surgeons using cadaveric knees to determine whether the surgeons could correctly identify reprocessed shavers. Thirty-nine shavers were tested; the surgeons were given both new and reprocessed shavers.

Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery.

Background Context: Recent studies have shown that prophylactic use of intrawound vancomycin in posterior instrumented spine surgery substantially decreases the incidence of wound infections requiring repeat surgery. Significant cost savings are thought to be associated with the use of vancomycin in this setting.

Purpose: To elucidate cost savings associated with the use of intrawound vancomycin in posterior spinal surgeries using a budget-impact model.

Utilization of Minimally Invasive Surgical Approach for Sacroiliac Joint Fusion in Surgeon Population of ISASS and SMISS Membership.

Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their members to examine current preferences in surgeon practice of MIS SI fusion.

Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?

Background: The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known.

Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis.

Introduction: There is increasing awareness of adult degenerative or de novo scoliosis, and its surgical treatment when indicated can be challenging and resource intense. Surgical randomized controlled trials are rare, and observational studies pose limitations because of the heterogeneity of surgical practices, techniques, and patient populations. Pooled analysis of current literature may identify effective treatment strategies and guide future efforts at prospective clinical research.

Are More Screws Better? A Systematic Review of Anchor Density and Curve Correction in Adolescent Idiopathic Scoliosis.

Study Design: Systematic review of clinical studies.

Objectives: To critically evaluate existing literature to determine whether increased anchor or implant density (screws, wires, and hooks per level fused) results in improved curve correction for adolescent idiopathic scoliosis (AIS) surgery.

Summary Of Background Data: Wide variability exists in the number of screws used for AIS surgery.

Comparison of cranial facet joint violation rates between open and percutaneous pedicle screw placement using intraoperative 3-D CT (O-arm) computer navigation.

Study Design: Retrospective study comparing cranial facet joint violation rates of open and percutaneous pedicle screws inserted using 3-dimensional image-guidance.

Objective: To determine the rate of cranial facet joint violation in intraoperative computed tomography (CT) image-guided lumbar pedicle screw instrumentation and compare facet joint violation rates between CT image-guided open and percutaneous techniques.

Summary Of Background Data: Facet joint violation by pedicle screws can potentially result in a higher rate of adjacent segment degeneration.