Instrumentation using robotics coupled with navigation in pediatric spine deformity surgery: a technical report of sacropelvic instrumentation.

Abstract

This technical report presents the intraoperative experience of using robotic-assisted navigation (RAN) for sacropelvic instrumentation in pediatric spine deformity surgery. A retrospective review of patients who underwent surgery using RAN for sacropelvic instrumentation at a single institution from 2019 to 2022 was conducted. In cases with screw confirmation imaging, screws were evaluated using the Gertzbein and Robbins classification scale. 52 cases were included. Average age at surgery was 14.1 years and 67.3% of patients were female. The most common diagnosis was spondylolisthesis (48.1%). The average major curve in scoliosis cases was 77°. A Schanz pin in the posterior superior iliac spine was placed in 98.1% of surgeries compared to 1 case with a spinous process clamp. Intraoperative 3D imaging scans (Scan & Plan) were used for 69.2% of the robotic registrations to the patient and intraoperative fluoroscopy-CT scans were used for 30.8%. 644 total screws were placed, with 427 placed robotically. Specifically, in the sacral-pelvic region, 98 S1, 18 S2, 58 S2AI, and 5 iliac screws were placed using RAN (179 screws). In 17 cases with 139 total robotic screws, post-instrumentation intraoperative 3D imaging or postoperative CT scans were obtained. Of these screws, 99.3% (138/139; 95% CI = 95.5-99.96) were placed accurately (Grade A or Grade B). One S2AI screw had an anterior breach on intraoperative 3D imaging scan and was changed prior to closure. Loss of RAN registration was observed in 2 cases (3.8%). No cases required return to the operating room for screw malposition. This study highlights high screw accuracy with no neurologic compromise associated with the use of RAN technology.