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Accuracy of S2 Alar-Iliac Screw Placement Under Robotic Guidance

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Abstract

Study Design

Case series.

Objectives

To determine the safety and feasibility of S2 alar-iliac (S2AI) screw placement under robotic guidance.

Summary of Background Data

Similar to standard iliac fixation, S2AI screws aid in achieving fixation across the sacropelvic junction and decreasing S1 screw strain. Fortunately, the S2AI technique minimizes prominent instrumentation and the need for offset connectors to the fusion construct. Herein, we present an analysis of the largest series of robotic-guided S2AI screws in the literature without any significant author conflicts of interest with the robotics industry.

Methods

Twenty-three consecutive patients who underwent spinopelvic fixation with 46 S2AI screws under robotic guidance were analyzed from 2015 to 2016. Screws were placed by two senior spine surgeons, along with various fellow or resident surgical assistants, using a proprietary robotic guidance system (Renaissance; Mazor Robotics Ltd., Caesara, Israel). Screw position and accuracy was assessed on intraoperative CT O-arm scans and analyzed using three-dimensional interactive viewing and manipulation of the images.

Results

The average caudal angle in the sagittal plane was 31.0° ± 10.0°. The average horizontal angle in the axial plane using the posterior superior iliac spine as a reference was 42.8° ± 6.6°. The average S1 screw to S2AI screw angle was 11.3° ± 9.9°. Two violations of the iliac cortex were noted, with an average breach distance of 7.9 ± 4.8 mm. One breach was posterior (2.2%) and one was anterior (2.2%). The overall robotic S2AI screw accuracy rate was 95.7%. There were no intraoperative neurologic, vascular, or visceral complications related to the placement of the S2AI screws.

Conclusions

Spinopelvic fixation achieved using a bone-mounted miniature robotic-guided S2AI screw insertion technique is safe and reliable. Despite two breaches, no complications related to the placement of the S2AI screws occurred in this series.

Level of Evidence

Level IV, therapeutic.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, 5141 Broadway, 3 Field West, New York, NY, 10034, USA

    Joseph L. Laratta MD, Jamal N. Shillingford MD, Joseph M. Lombardi MD, Rami G. Alrabaa MD, Barlas Benkli MD, Lawrence G. Lenke MD & Ronald A. Lehman MD

  2. Department of Orthopaedic Surgery, The Hospital for Joint Diseases at New York University, New York, NY, USA

    Charla Fischer MD

Authors
  1. Joseph L. Laratta MD
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  2. Jamal N. Shillingford MD
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  3. Joseph M. Lombardi MD
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  4. Rami G. Alrabaa MD
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  5. Barlas Benkli MD
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  6. Charla Fischer MD
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  7. Lawrence G. Lenke MD
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  8. Ronald A. Lehman MD
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Corresponding author

Correspondence to Joseph L. Laratta MD.

Additional information

JLL (none); JNS (none); JML (none); RGA (none); BB (none); LGL (other from board membership: Orthopaedic Research and Education Foundation and Global Spine Outreach; personal fees from consultancy: DePuy Synthes Spine, K2M, Medtronic; personal fees from expert testimony: Fox Rothschild; grants from AO-Spine, Scoliosis Research Society, DePuy Synthes Spine, Setting Scoliosis Straight Foundation, EOS; other from royalties; personal fees from travel accommodations/meeting expenses: AOSpine, Broadwater, Seattle Science Foundation, Scoliosis Research Society, The Spinal Research Foundation; fellowship grant: AOSpine, North America; grants from philanthropic research funding, outside the submitted work; in addition, LGL has a patent Medtronic pending); RAL (reports grants from PRORP [Department of Defense Peer Reviewed Orthopaedic Research Program], personal fees and nonfinancial support from DePuy Synthes Spine, Stryker, and Medtronic, outside the submitted work).

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Laratta, J.L., Shillingford, J.N., Lombardi, J.M. et al. Accuracy of S2 Alar-Iliac Screw Placement Under Robotic Guidance. Spine Deform 6, 130–136 (2018). https://doi.org/10.1016/j.jspd.2017.08.009

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  • DOI: https://doi.org/10.1016/j.jspd.2017.08.009

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