title: Robot-assisted vertebral body augmentation: a radiation reduction tool.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  To assess radiation exposure time during robot-guided vertebral body augmentation compared with other published findings.
  
  
  BACKGROUND
  Rising incidence of vertebral compression fractures in the aging population result in widespread use of vertebral body cement augmentation with significant radiation exposure to the surgeon, operating room staff, and patient. Radiation exposure leads to higher cancer rates among orthopedic and spine surgeons and patients.
  
  
  METHODS
  Thirty-three patients with 60 vertebral compression fractures underwent robot-guided vertebral body augmentation performed by 2 surgeons simultaneously injecting cement at 2 levels under pulsed fluoroscopy. The age of patients was in the range from 29 to 92 (mean, 67 yr). One to 6 vertebrae were augmented per case (average 2). Twenty-five patients had osteoporotic fractures and 8 had pathological fractures. Robotic guidance data included execution rate, accuracy of guidance, total surgical time, and time required for robotic guidance. Radiation-related data included the average preoperative computed tomographic effective dose, radiation time for calibration, registration, placement of Kirschner wires, and total procedure radiation time. Radiation time per level and surgeon's exposure were calculated.
  
  
  RESULTS
  Kyphoplasty was performed in 15 patients (1 sacroplasty), vertebroplasty in 13, and intravertebral expanding implants in 5. The average preoperative computed tomographic effective dose was 50 mSv (18-81). Average operative time was 118 minutes (49-350). Mean robotic guidance took 36 minutes. Average operative radiation time was 46.1 seconds per level (33-160). Average exposure time of the surgeons and the operating room staff per augmented level was 37.6 seconds. The execution rate was 99%, with an accuracy of 99%. Two complications (hemothorax and superficial wound infection) occurred.
  
  
  CONCLUSIONS
  The radiation exposure of the surgeon and the operating room staff in a series of robot-assisted vertebral body augmentation was 74% lower than published results on fluoroscopy guidance and approximately 50% lower than the literature on navigated augmentation.
  
  
  METHODS
  4.
authors.affiliation: *Departments of Orthopedic Surgery †Radiology; and ‡Neurosurgery, Hadassah-Hebrew-University Medical Center, Jerusalem, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Barzilay
authors.forename: Josh E
authors.initials: JE
authors.lastname: Schroeder
authors.forename: Nurith
authors.initials: N
authors.lastname: Hiller
authors.forename: Gordon
authors.initials: G
authors.lastname: Singer
authors.forename: Amir
authors.initials: A
authors.lastname: Hasharoni
authors.forename: Ori
authors.initials: O
authors.lastname: Safran
authors.forename: Meir
authors.initials: M
authors.lastname: Liebergall
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
authors.forename: Leon
authors.initials: L
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery*