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Use of a high-speed drill in robotics coupled with navigation for pediatric spine surgery

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Abstract

With the increasing number of surgeries for pediatric spinal deformities, the aim has been to reduce the associated complications, such as those caused by screw malposition. This case series is an intra-operative experience with a new navigated high-speed revolution drill (Mazor Midas, Medtronic, Minneapolis, MN) for pediatric spinal deformity to assess accuracy and workflow. 88 patients, ranging from 2 to 29 years of age, were included who underwent posterior spinal fusion with the navigated high-speed drill. Diagnoses, Cobb angles, imaging, surgical time, complications, and total number of screws placed are described. Screw positioning was evaluated using fluoroscopy, plain radiography, and CT. Mean age was 15.4 years old. Diagnoses included 47 adolescent idiopathic scoliosis, 15 neuromuscular scoliosis, 8 spondylolisthesis, 4 congenital scoliosis, and 14 other. The mean Cobb angulation for scoliosis patients was 64° and the mean number of levels fused was 10. 81 patients had registration via intraoperative 3-D imaging and 7 had pre-operative CT scan to fluoroscopy registration. There were a total of 1559 screws with 925 placed robotically. 927 drill paths were drilled with the Mazor Midas. 926 out of 927 drill paths were accurate. The mean surgical time was 304 min with the mean robotic time being 46 min. This is the first intra-operative report to our knowledge documenting the experience with the Mazor Midas drill in pediatric spinal deformity showing decreased skiving potential, decreased torque when drilling, and lastly increased accuracy. Level of evidence: level III.

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Funding

This study was funded by the Department of Orthopedic Surgery at Boston Children’s Hospital. External funding was provided in part through research support by Medtronic. Daniel Hedequist, MD is a Medtronic Consultant.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Frank Mota, Nicole Welch, Craig Birch & Daniel Hedequist

  2. Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Blake K. Montgomery

  3. Harvard Medical School, Boston, MA, USA

    Craig Birch & Daniel Hedequist

Authors
  1. Frank Mota
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  2. Nicole Welch
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  3. Blake K. Montgomery
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  4. Craig Birch
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  5. Daniel Hedequist
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Contributions

Frank Mota, MD, Lead author, acquisition of data for the work, statistical analysis, assistance with data interpretation for the work, drafting the work, final approval of the version to be published, agreement to be accountable for all aspects of the work. Nicole Welch, BA, Acquisition of data for the work, critical review of the work, final approval of the version to be published, agreement to be accountable for all aspects of the work. Craig Birch, MD, Critical review of the work, final approval of the version to be published, agreement to be accountable for all aspects of the work. Daniel Hedequist, MD, Senior author, conception and design of the work, drafting the work, critical review of the work, final approval of the version to be published, agreement to be accountable for all aspects of the work. Blake K. Montgomery significantly contributed to assistance with data interpretation for the work, drafting the work, final approval of the version to be published, agreement to be accountable for all aspects of the work.

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Correspondence to Daniel Hedequist.

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The authors declare no competing interests relevant to the content of this article.

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This study was conducted under the Boston Children’s Hospital Institutional Review Board.

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Mota, F., Welch, N., Montgomery, B. et al. Use of a high-speed drill in robotics coupled with navigation for pediatric spine surgery. J Robotic Surg 17, 1511–1516 (2023). https://doi.org/10.1007/s11701-023-01534-w

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  • DOI: https://doi.org/10.1007/s11701-023-01534-w

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