Int J Med Robot - Robotic system for cervical spine surgery.

Tópicos

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Resumo

CKGROUND: In contemporary surgical clinical practice, spinal instability is often treated with mechanical stabilization techniques in order to protect the spinal cord and nerve roots. These techniques involve placing screws in defined regions of the vertebrae, typically the pedicle, where the strongest bone is found. The challenge for the surgeon is the accurate placement of screws for good mechanical purchase and to avoid damage to surrounding vital anatomical structures. This is especially critical in the cervical region, where the target bone mass is smaller and the spinal cord, nerve roots and vertebral arteries are all at risk. A robotic system enabling the surgeon to precisely place implants into the vertebrae should enhance safety and may potentially improve surgical results.METHODS: We describe such a system, which consists of a compact robot positioned using a passive structure, an optical tracking system, a surgical input device and planning and navigational software. The implant trajectory in each vertebra is planned preoperatively, using fine-cut computerized tomography (CT) scans. During surgery, registration matching between the CT scan and the patient's anatomy is achieved using point to point registration, refined with a surface merge technique. Approximate robot positioning is done passively by the surgeon. Final precise instrument positioning is performed by the robot according to the planned trajectory through the target vertebra. Implants (screws) are then placed through the robot-guided working channel.RESULTS: Six cadaver experiments, consisting of placing transarticular (i.e. crossing the joints between the vertebrae) screws in the upper two vertebrae of the human cervical spine, were performed. Implant placement accuracy was comparable with that achieved using freehand image-guided techniques by an experienced surgeon.CONCLUSIONS: These results confirm the utility and applicability of the system. It is currently in redesign to improve accuracy and to render it compatible with on-line planning.

Resumo Limpo

ckground contemporari surgic clinic practic spinal instabl often treat mechan stabil techniqu order protect spinal cord nerv root techniqu involv place screw defin region vertebra typic pedicl strongest bone found challeng surgeon accur placement screw good mechan purchas avoid damag surround vital anatom structur especi critic cervic region target bone mass smaller spinal cord nerv root vertebr arteri risk robot system enabl surgeon precis place implant vertebra enhanc safeti may potenti improv surgic resultsmethod describ system consist compact robot posit use passiv structur optic track system surgic input devic plan navig softwar implant trajectori vertebra plan preoper use finecut computer tomographi ct scan surgeri registr match ct scan patient anatomi achiev use point point registr refin surfac merg techniqu approxim robot posit done passiv surgeon final precis instrument posit perform robot accord plan trajectori target vertebra implant screw place robotguid work channelresult six cadav experi consist place transarticular ie cross joint vertebra screw upper two vertebra human cervic spine perform implant placement accuraci compar achiev use freehand imageguid techniqu experienc surgeonconclus result confirm util applic system current redesign improv accuraci render compat onlin plan

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