title: Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis.
abstract: OBJECTIVE
  While image guidance and neuronavigation have enabled a more accurate placement of pedicle implants, they can inconvenience the surgeon. Robot-assisted placement of pedicle screws appears to overcome these disadvantages. However, recent data concerning the superiority of currently available robots in assisting spinal surgeons are conflicting. The aim of our study was to evaluate the percentage of accurately placed pedicle screws, inserted using a new robotic-guidance system.
  
  
  METHODS
  20 Patients were operated on successively by the same surgeon using robotic assistance (ROSA™, Medtech) (Rosa group 10 patients, n = 40 screws) or by the freehand conventional technique (Freehand group 10 patients, n = 50 screws). Patient characteristics as well as the duration of the operation and of exposure to X rays were recorded.
  
  
  RESULTS
  The mean age of patients in each group (RG and FHG) was 63 years. Mean BMI and operating time among the RG and FHG were, respectively, 26 and 27 kg/m(2), and 187 and 119 min. Accurate placement of the implant (score A and B of the Gertzbein Robbins classification) was achieved in 97.3% of patients in the RG (n = 36) and in 92% of those in the FHG (n = 50). Four implants in the RG were placed manually following failed robotic assistance.
  
  
  CONCLUSIONS
  We report a higher rate of precision with robotic as compared to the FH technique. Providing assistance by permanently monitoring the patient's movements, this image-guided tool helps more accurately pinpoint the pedicle entry point and control the trajectory. Limitations of the study include its small sized and non-randomized sample. Nevertheless, these preliminary results are encouraging for the development of new robotic techniques for spinal surgery.
authors.affiliation: Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France. nlonjon@gmail.com.|INSERM U1051, Institute for Neurosciences of Montpellier, Pathophysiology and Therapy of Sensory and Motor Deficits, Hôpital Saint Eloi, Montpellier, France. nlonjon@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lonjon
authors.affiliation: Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Chan-Seng
authors.affiliation: Department of Neuroradiology, Hôpital Gui de Chauliac, 34090, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Costalat
authors.affiliation: Department of Clinic Research, Hôpital la Colombière, 39 Avenue Charles Flahault, 34295, Montpellier, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Bonnafoux
authors.affiliation: Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Vassal
authors.affiliation: Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Boetto
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D013123:Spinal Fusion / Q000379:methods*
keywords: Degenerative disease; Lumbar; Robot-assisted; Spine surgery