Skip to main content

Advertisement

SpringerLink
Log in

Robotic-assisted percutaneous iliac screw fixation for destructive lumbosacral metastatic lesions: an early single-institution experience

  • Technical Note - Neurosurgical technique evaluation
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Robotic-assisted surgery is becoming more widely applied in surgical subspecialties due to its intraoperative and postoperative advantages such as minimally invasive approach, reduced blood loss, shorter hospital stay, and decreased incidence of postoperative complications. However, robotic devices were only recently introduced in the field of spinal surgery. Specifically, percutaneous approaches involving computer-assisted image guidance are relatively new in iliac screw fixation. Previous methods focused on the use of S2-alar-iliac (S2AI) screw fixation which allows for pelvic fixation without a need for side connectors. However, for patients with destructive lesions of the sacrum, placement of these S2AI screws may not be feasible. The purpose of this technical note is to illustrate the implementation of robotic-assisted percutaneous iliac screw fixation in two cases which allows for minimally invasive attachment to the proximal lumbar screws without a side connector and eliminates a potential source of instrumentation failure.

Methods

Robotic-assisted percutaneous iliac screw fixation was performed on two patients. The robotics system was used to merge the fluoroscopic images with intraoperative computed tomography (CT) images to plan the trajectories for placement of bilateral pedicle and iliac screws. Intraoperative CT scan was again performed to confirm proper placement of all screws. Rods were then engaged bilaterally with the pedicle and iliac screws without the use of side connectors.

Results

The patients did not experience immediate postoperative complications and had stable hardware at one-month follow-up. Our cases demonstrate the surgical efficiency of robotic-assisted lumbo-iliac instrumentation which obviates the need to use a side connector, which is commonly used in iliac fixation. This eliminates a step, which can reduce the possibility of instrumentation failure.

Conclusion

Robotic-assisted percutaneous iliac screw fixation is a safe and feasible technique to improve operative and clinical outcomes in complex spinal instrumentation surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Beutler WJ, Peppelman WC Jr, DiMarco LA (2013) The da Vinci robotic surgical assisted anterior lumbar interbody fusion: technical development and case report. Spine (Phila Pa 1976) 38:356–363. https://doi.org/10.1097/BRS.0b013e31826b3d72

    Article  Google Scholar 

  2. Buell TJ, Yener U, Wang TR, Buchholz AL, Yen CP, Shaffrey ME, Shaffrey CI, Smith JS (2020) Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm. J Neurosurg Spine:1–12. https://doi.org/10.3171/2019.12.SPINE191148

  3. Feiz-Erfan I, Fox BD, Nader R, Suki D, Chakrabarti I, Mendel E, Gokaslan ZL, Rao G, Rhines LD (2012) Surgical treatment of sacral metastases: indications and results. J Neurosurg Spine 17:285–291. https://doi.org/10.3171/2012.7.SPINE09351

    Article  PubMed  Google Scholar 

  4. Harrop JS, Jeyamohan SB, Sharan A, Ratliff J, Vaccaro AR (2009) Iliac bolt fixation: an anatomic approach. J Spinal Disord Tech 22:541–544. https://doi.org/10.1097/BSD.0b013e31818da3e2

    Article  PubMed  Google Scholar 

  5. Hoeckelmann M, Rudas IJ, Fiorini P, Kirchner F, Haidegger T (2015) Current capabilities and development potential in surgical robotics. Int J Adv Rob Syst 12:61. https://doi.org/10.5772/60133

    Article  Google Scholar 

  6. Hu X, Scharschmidt TJ, Ohnmeiss DD, Lieberman IH (2015)Robotic assisted surgeries for the treatment of spine tumorsInt J Spine Surg 9.https://doi.org/10.14444/2001

  7. Jain D, Manning J, Lord E, Protopsaltis T, Kim Y, Buckland AJ, Bendo J, Fischer C, Goldstein J (2019) Initial single-institution experience with a novel robotic-navigation system for thoracolumbar pedicle screw and pelvic screw placement with 643 screws. Int J Spine Surg 13:459–463. https://doi.org/10.14444/6060

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jamshidi Aria M, Massel Dustin H, Liounakos Jason I, Silman Zmira, Good Christopher R, Schroerlucke Samuel R, Cannestra Andrew, Hsu Victor, Lim Jae, Zahrawi Faissal, Ramirez Pedro M, Sweeney Thomas M, Wang Michael Y (2020) Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. Int J Med Robot 17(2):e2188. https://doi.org/10.1002/rcs.2188

    Article  PubMed  Google Scholar 

  9. Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V (2011) Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 20:860–868. https://doi.org/10.1007/s00586-011-1729-2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kobayashi K, Ando K, Nakashima H, Sato K, Kanemura T, Yoshihara H, Hirasawa A, Kato F, Ishiguro N, Imagama S (2020) Prognostic factors in the new Katagiri scoring system after palliative surgery for spinal metastasis. Spine (Phila Pa 1976) 45:E813–E819. https://doi.org/10.1097/BRS.0000000000003415

    Article  Google Scholar 

  11. Lombardi JM, Shillingford JN, Lenke LG, Lehman RA (2018) Sacropelvic fixation: when, why, how? Neurosurg Clin N Am 29:389–397. https://doi.org/10.1016/j.nec.2018.02.001

    Article  PubMed  Google Scholar 

  12. Mao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, Pollina J (2021) Technologic evolution of navigation and robotics in spine surgery: a historical perspective. World Neurosurg 145:159–167. https://doi.org/10.1016/j.wneu.2020.08.224

    Article  PubMed  Google Scholar 

  13. Molina CA, Gokaslan ZL, Sciubba DM (2011) A systematic review of the current role of minimally invasive spine surgery in the management of metastatic spine disease. Int J Surg Oncol 2011:598148. https://doi.org/10.1155/2011/598148

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nanda A, Manghwani J, Kluger PJ (2020) Sacropelvic fixation techniques - current update. Journal of clinical orthopaedics and trauma 11:853–862. https://doi.org/10.1016/j.jcot.2020.07.022

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nguyen JH, Buell TJ, Wang TR, Mullin JP, Mazur MD, Garces J, Taylor DG, Yen CP, Shaffrey CI, Smith JS (2019) Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up. J Neurosurg Spine:1–9. https://doi.org/10.3171/2018.9.SPINE18239

  16. O’Brien JR, Yu WD, Bhatnagar R, Sponseller P, Kebaish KM (2009) An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976) 34:E439-442. https://doi.org/10.1097/BRS.0b013e3181a4e3e4

    Article  Google Scholar 

  17. Shin JH, Hoh DJ, Kalfas IH (2012) Iliac screw fixation using computer-assisted computer tomographic image guidance: technical note. Neurosurgery 70:16–20. discussion 20.https://doi.org/10.1227/NEU.0b013e318230517a

    Article  PubMed  Google Scholar 

  18. Sutterlin CE 3rd, Field A, Ferrara LA, Freeman AL, Phan K (2016) Range of motion, sacral screw and rod strain in long posterior spinal constructs: a biomechanical comparison between S2 alar iliac screws with traditional fixation strategies. J Spine Surg 2:266–276. https://doi.org/10.21037/jss.2016.11.01

    Article  PubMed  PubMed Central  Google Scholar 

  19. von Glinski A, Yilmaz E, Ishak B, Hayman E, Ramey W, Jack A, Iwanaga J, Oskouian RJ, Tubbs RS, Chapman JR (2020) The modified iliac screw: an anatomic comparison and technical guide. World Neurosurg 136:e608–e613. https://doi.org/10.1016/j.wneu.2020.01.091

    Article  Google Scholar 

  20. Wang MY, Williams S, Mummaneni PV, Sherman JD (2016) Minimally invasive percutaneous iliac screws: initial 24 case experiences with CT confirmation. Clin Spine Surg 29:E222-225. https://doi.org/10.1097/BSD.0b013e3182733c43

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Spine, Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Durham, NC, 27710, USA

    Christine Park, Clifford Crutcher, Vikram A. Mehta, Timothy Y. Wang, Khoi D. Than, Isaac O. Karikari, C. Rory Goodwin & Muhammad M. Abd-El-Barr

Authors
  1. Christine Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clifford Crutcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikram A. Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khoi D. Than
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isaac O. Karikari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Rory Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Muhammad M. Abd-El-Barr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammad M. Abd-El-Barr.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurosurgical technique evaluation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, C., Crutcher, C., Mehta, V.A. et al. Robotic-assisted percutaneous iliac screw fixation for destructive lumbosacral metastatic lesions: an early single-institution experience. Acta Neurochir 163, 2983–2990 (2021). https://doi.org/10.1007/s00701-021-04894-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-021-04894-0

Keywords

Search

Navigation