Advertisement

European Spine Journal

, Volume 26, Issue 3, pp 720–725 | Cite as

Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy

  • Xiaobang Hu
  • Isador H. Lieberman
Original Article

Abstract

Purpose

To review our experience with robotic guided S2-alar iliac (S2AI) screw placement.

Methods

We retrospectively reviewed patients who underwent S2AI fixation with robotic guidance. Screw placement and deviation from the preoperative plan were assessed by fusing preoperative CT (with the planned S2AI screws) to postoperative CT. The software’s measurement tool was used to compare the planned vs. actual screw placements in axial and lateral views, at entry point to the S2 pedicle and at a 30 mm depth at the screws’ mid-shaft, in a resolution of 0.1 mm. Medical charts were reviewed for technical issues and intra-operative complications.

Results

35 S2AI screws were reviewed in 18 patients. The patients’ mean age was 60 years. No intra-operative complications that related to the placement of S2AI screws were reported and robotic guidance was successful in all 35 screws. Post-operative CT scans showed that all trajectories were accurate. No violations of the iliac cortex or breaches of the anterior sacrum were noted. At the entry point, the screw deviated from the pre-operative plan by 3.0 ± 2.2 mm in the axial plane and 1.8 ± 1.6 mm in the lateral plane. At 30 mm depth, the screw deviated from the pre-operative plan by 2.1 ± 1.3 mm in the axial plane and 1.2 ± 1.1 mm in the lateral plane.

Conclusions

Robotic guided S2AI screw placement is feasible and accurate. No screw malpositions or complications that related to the placement of S2AI screws occurred in this series. Larger studies are needed to assess the long-term clinical outcomes of robotic guided sacral-pelvic fixation.

Keywords

S2-alar iliac screw Robotic guidance Accuracy Adult spinal deformity 

Notes

Acknowledgments

We thank Josh Lieberman for creating the drawing of S2AI screws and Dr. Samuel Bederman for his help with the intra-operative photos.

Compliance with ethical standards

Conflict of interest

Xiaobang Hu received a travel support from Mazor Robotics in 2011. Isador H. Lieberman receives royalty, intellectual property rights, consulting fee and ownership interest from Mazor Robotics.

Source of funding

No funds were received in support of this work. The device that is the subject of this manuscript is FDA-approved for this indication. This study has been approved by Texas Health Resources IRB.

References

  1. 1.
    Bridwell KH, Edwards CC 2nd, Lenke LG (2003) The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct. Spine 28:S234–S242CrossRefPubMedGoogle Scholar
  2. 2.
    Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27:776–786CrossRefPubMedGoogle Scholar
  3. 3.
    Kebaish KM (2010) Sacropelvic fixation: techniques and complications. Spine 35:2245–2251CrossRefPubMedGoogle Scholar
  4. 4.
    Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C (2006) Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine 31:303–308CrossRefPubMedGoogle Scholar
  5. 5.
    Polly DW, Jr (2015) The Sacroiliac joint and long lumbosacral fusions. surgery for the painful, dysfunctional sacroiliac joint. Springer, pp 151–158Google Scholar
  6. 6.
    O’Brien JR, Yu W, Kaufman BE, Bucklen B, Salloum K, Khalil S, Gudipally M (2013) Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. Spine 38:E1250–E1255CrossRefPubMedGoogle Scholar
  7. 7.
    Hu X, Lieberman IH (2014) What is the learning curve for robotic-assisted pedicle screw placement in spine surgery? Clin Orthop Relat Res 472:1839–1844CrossRefPubMedGoogle Scholar
  8. 8.
    Lieberman IH, Togawa D, Kayanja MM, Reinhardt MK, Friedlander A, Knoller N, Benzel EC (2006) Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: Part I—Technical development and a test case result. Neurosurgery 59:641–650 (discussion 641650)Google Scholar
  9. 9.
    Togawa D, Kayanja MM, Reinhardt MK, Shoham M, Balter A, Friedlander A, Knoller N, Benzel EC, Lieberman IH (2007) Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: part 2—Evaluation of system accuracy. Neurosurgery 60:ONS129-139 (discussion ONS139)Google Scholar
  10. 10.
    Ray WZ, Ravindra VM, Schmidt MH, Dailey AT (2013) Stereotactic navigation with the O-arm for placement of S-2 alar iliac screws in pelvic lumbar fixation. J Neurosurg 18:490–495Google Scholar
  11. 11.
    Chang TL, Sponseller PD, Kebaish KM, Fishman EK (2009) Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine 34:436–440CrossRefPubMedGoogle Scholar
  12. 12.
    Sponseller PD, Zimmerman RM, Ko PS, Pull Ter Gunne AF, Mohamed AS, Chang TL, Kebaish KM (2010) Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine 35:1887–1892CrossRefPubMedGoogle Scholar
  13. 13.
    Ughwanogho E, Flynn JM (2010) Current navigation modalities in spine surgery. Univ Pa Orthop J 20:65–69Google Scholar
  14. 14.
    Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ (2012) Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine 37:E188–E194CrossRefPubMedGoogle Scholar
  15. 15.
    Patil S, Lindley EM, Burger EL, Yoshihara H, Patel VV (2012) Pedicle screw placement with O-arm and stealth navigation. Orthopedics 35:e61–e65CrossRefPubMedGoogle Scholar
  16. 16.
    Putzier M, Strube P, Cecchinato R, Lamartina C, Hoff E (2014) A new navigational tool for pedicle screw placement in patients with severe scoliosis: a pilot study to prove feasibility, accuracy, and identify operative challenges. J Spinal Disord TechGoogle Scholar
  17. 17.
    Bederman SS, Hahn P, Colin V, Kiester DP, Bhatia NN (2015) Robotic guidance for S2-alar-iliac screws in spinal deformity correction. J Spinal Disord TechGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Scoliosis and Spine Tumor Center, Texas Back InstituteTexas Health Presbyterian Hospital PlanoPlanoUSA

Personalised recommendations