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Analysis of 5,070 consecutive pedicle screws placed utilizing robotically assisted surgical navigation in 334 patients by experienced pediatric spine deformity surgeons: surgical safety and early perioperative complications in pediatric posterior spinal fusion

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Abstract

Purpose

This study evaluates the intraoperative and short-term complications associated with robotically assisted pedicle screw placement in pediatric posterior spinal fusion (PSF) from three surgeons at two different institutions.

Methods

We retrospectively reviewed 334 pediatric patients who underwent PSF with robotic-assisted navigation at 2 institutions over 3 years (2020–2022). Five thousand seventy robotically placed screws were evaluated. Data collection focused on intraoperative and early postoperative complications with minimum 30-day follow-up. Patients undergoing revision procedures were excluded.

Results

Intraoperative complications included 1 durotomy, 6 patients with neuromonitoring alerts not related to screw placement, and 62 screws (1.2%) with documented pedicle breaches, all of which were revised at time of surgery. By quartile, pedicle breaches statistically declined from first quartile to fourth quartile (1.8% vs. 0.56%, p < 0.05). No breach was associated with neuromonitoring changes or neurological sequelae. No spinal cord or vascular injuries occurred. Seventeen postoperative complications occurred in eleven (3.3%) of patients. There were five (1.5%) patients with unplanned return to the operating room.

Conclusion

Robotically assisted pedicle screw placement was safely and reliably performed on pediatric spinal deformity by three surgeons across two centers, demonstrating an acceptable safety profile and low incidence of unplanned return to the operating room.

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Funding

There were no external supports for funding.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Roger F. Widmann, Jenna L. Wisch, Olivia C. Tracey, Colson P. Zucker, Gabriel S. Linden & Jessica H. Heyer

  2. Children’s Hospital Colorado, Aurora, CO, 80045, USA

    Tyler Feddema, Florian Miller & Mark Erickson

Authors
  1. Roger F. Widmann
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  2. Jenna L. Wisch
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  4. Colson P. Zucker
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  7. Gabriel S. Linden
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  9. Jessica H. Heyer
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Contributions

RFW: conception of design or work. JLW, JLW, OCT, CPZ, TF, FM: data collection. JLW, JLW, OCT: writing—original draft preparation. RFW: revision of work. RFW, JLW, JLW, OCT, CPZ, TF, FM: approval of final version of manuscript. RFW, JLW, JLW, OCT, CPZ, TF, FM: agree to be accountable for the work. ME, JHH: conception of design or work. GSL: data collection. JHH: writing—original draft preparation. ME, JHH: revision of work. GSL, ME, JHH: approval of final version of manuscript. GSL, ME, JHH: agree to be accountable for the work.

Corresponding author

Correspondence to Jessica H. Heyer.

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Conflict of interest

Roger Widmann is a paid consultant for SpineGuard, which is not discussed in this study. Mark Erickson is a pain consultant for Medtronic. The remaining authors have no disclosures pertinent to this study.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Boards at the Hospital for Special Surgery and Children’s Hospital Colorado.

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Widmann, R.F., Wisch, J.L., Tracey, O.C. et al. Analysis of 5,070 consecutive pedicle screws placed utilizing robotically assisted surgical navigation in 334 patients by experienced pediatric spine deformity surgeons: surgical safety and early perioperative complications in pediatric posterior spinal fusion. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00854-7

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