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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn a session focusing on computer-assisted surgery, 6 presenters covered the new options for tools and techniques and the evidence for different approaches. Overall, these new tools and approaches can improve accuracy, reduce radiation exposure, potentially shorten operating times, and reduce costs.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures Spine Conditions\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIn a session focusing on computer-assisted surgery, 6 presenters covered the new options for tools and techniques and the evidence for different approaches. Overall, these new tools and approaches can improve accuracy, reduce radiation exposure, potentially shorten operating times, and reduce costs.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ERussell H. Taylor, PhD, The Johns Hopkins University, Baltimore, Maryland, USA, discussed computer-assisted techniques, noting that while robotic tools have been used extensively in other surgical areas, their use in spine surgery is relatively new.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDr Taylor emphasized that three components\u2014humans, technology, and information\u2014must interact smoothly for these new approaches to be successful. He first described the ROBODOC robot, developed \u0026gt; 20 years ago, which was used for joint replacement surgery based on computed tomography (CT) images [Taylor et al. \u003Cem\u003EIEEE Trans Rob Aut.\u003C\/em\u003E 1994]. To illustrate emerging systems, he described experimental work combining cone-beam CT images with the da Vinci Surgical System and augmented reality displays to provide more information during transoral robotic surgery [Liu et al. \u003Cem\u003EJ Robot Surg\u003C\/em\u003E. 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAccording to Dr Taylor, emerging computer-integrated surgery systems combine available information about a specific patient (eg, imaging) and general information based on statistics to develop a plan for the operating room. In the operating room, all of this information is \u201cregistered\u201d to the physical patient. Once this is done, then the system can use appropriate technology to assist the physician to carry out the surgical plan and to perform postoperative assessments. The information generated in this process can be analyzed statistically to determine what is effective and appropriate, allowing improvements in treatment.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EWhen using robots, it is possible to analyze and interpret movements of the machine. This can help improve treatment, and develop skills and training (eg, as a way to objectively assess the progress of residents and fellows).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAccording to Dr Taylor, while robots are not always necessary, their use in many cases can make surgery less invasive, safer, more consistent, more precise, and more cost-effective. In the future, all of the data available from robots and computer systems may be integrated with the hospital database to provide better outcomes and quality for improved patient care.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EMichael MacMillan, MD, Southeastern Integrated Medical, Gainesville, Florida, USA, addressed current options available for computer-guided surgery. He first emphasized the importance of ensuring that the image of the spine and images of tools are working together accurately. A preoperative CT scan (ie, digital image of the spine) needs to be superimposed by physically touching the spine to see if there is a match with the image. This approach has been replaced by the use of fluoroscopic registration, which provides a high level of accuracy. A fluoroscopic image is created using the preoperative image and compared with a fluoroscopic image of the actual spine.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EA synthetic fluoroscopic image\u2014an image created from a preoperative digital image\u2014has the advantage of faster registration and does not require landmarks to be exposed, making it suitable for minimally invasive surgery. However, it can sometimes be inaccurate and does not allow landmarks to be verified in real time (eg, if structures move during surgery or were positioned differently during the CT scan).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EIntraoperative CT (in which the CT scan is taken in the operating room) has the advantage of allowing images to be taken while the patient is in position for surgery. However, sterility is a concern and this process disrupts the normal operative flow.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe new Mazor Robotics Renaissance Guidance System has a more nuanced approach because individual segments are examined, meaning that each vertebra has its own registration and preoperative plan. It improves accuracy, lowers costs, and does not require a camera that can obstruct visibility. This system does require a frame attached along the length of the spine, preoperative planning, and a drill guide on the attached frame. Additionally, it can only be used for pedicle screws at this time.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003ESrinivas K. Prasad, MD, Thomas Jefferson University, Philadelphia, Pennsylvania, USA, addressed the outcomes of current approaches in image-guided surgery. He began by emphasizing the importance of clarity when defining accuracy, as it can be used in different ways and can lead to a false sense of security. Additionally, even though many meta-analyses have been conducted, these have limitations such as variable accuracy assessment methods, heterogeneous patient populations and conditions, and disparate inclusion criteria for navigation. There also have been few prospective studies. Accuracy numbers may include a variety of patients and the direction of the breach often is not considered.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAs new technologies have been developed, the level of accuracy has increased and tightened. Some studies suggest that certain regions and anatomical areas may be most sensitive to these new technologies. For example, one study indicated that accuracy rates improved the most with fluoroscopic vs conventional navigation in the thoracic region (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Mason et al. \u003Cem\u003EJ Neurosurg Spine\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Accuracy Rate by Anatomical Region\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1998785901\u0022 data-figure-caption=\u0022Accuracy Rate by Anatomical Region\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15387\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EAccuracy Rate by Anatomical Region\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003E2D, 2-dimensional; 3D, 3-dimensional.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from Mason A et al. The accuracy of pedicle screw placement using intraoperative image guidance systems. \u003Cem\u003EJ Neurosurg Spine\u003C\/em\u003E. 2014;20:196\u2013203. With permission from American Association of Neurological Surgeons.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAccuracy is influenced by clinician experience. In one study, over time, computer-assisted navigation decreased the perforation rate and operative time [Bai et al. \u003Cem\u003EChin Med J (Engl)\u003C\/em\u003E. 2010]. Despite this information on accuracy, there is insufficient information about how anatomy accuracy relates to patient benefits and outcomes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EEric W. Nottmeier, MD, St. Vincent\u0027s Spine and Brain Institute, Jacksonville, Florida, USA, related data on the use of computer-assisted systems in spine surgery to cost-effectiveness. For health insurance company and hospital staff to support the use of these technologies, they must believe that the approaches are cost-effective. Marketing (as has been done for the da Vinci Surgical System) could increase patient demand. Additionally, these approaches may reduce operating room time, reduce mistakes and associated costs, and allow the use of standard (rather than cannulated) screws. Dr Nottmeier presented a theoretical model showing potential savings in the operating room and instrumentation savings, suggesting a potential annual savings of \u2265 $500 000.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EBawarjan Schatlo, MD, University of G\u00f6ttingen, G\u00f6ttingen, Germany, presented details of the robotic systems currently available, including the ROSA Spine System and Mazor SpineAssist.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EDr Schatlo thoroughly discussed the Mazor Renaissance and SpineAssist robot family, which is mainly used to assist surgeons in placing pedicle screws. The former generation of this robot (SpineAssist) has now been in use for half a decade and therefore has been the focus of most of the presently available publications on robotic spine surgery. The reported accuracy rates of this system in clinical studies vary between 85% and 100%, which represents the proportion of screws with \u0026lt; 2-mm deviation from a perfect trajectory. Interestingly, most screw deviations observed in robot cases were lateral inaccuracies (70%) and as such were not deleterious to neural structures while lateral and medial misplacement in the freehand group were roughly equal [Ringel et al. \u003Cem\u003ESpine\u003C\/em\u003E. 2012]. A preliminary but prospective study with a solid randomized design demonstrated an accuracy rate of approximately 97% with no cases of neurological injury and a decrease in radiation exposure [Roser et al. \u003Cem\u003ENeurosurgery\u003C\/em\u003E. 2013]. One study suggested that physicians could expect to acquire proficiency in the use of the robotic guidance system after about 30 surgeries [Hu X, Lieberman IH. \u003Cem\u003EClin Orthop Relat Res.\u003C\/em\u003E 2014]. Dr Schatlo also noted that physicians who work with these systems should always remain prepared to switch to conventional techniques of pedicle screw insertion [Schatlo et al. \u003Cem\u003EJ Neurosurg Spine\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EHe also briefly described the ROSA Spine System and the da Vinci Surgical System. The ROSA Spine System is the successor of the Neuromate and has a different concept from the Mazor SpineAssist. After intraoperative imaging and planning, the robot guides the surgeon in placing pedicle screws. Preliminary studies in Europe have shown promising results, but the system has not yet been approved by the US Food and Drug Administration. Dr Schatlo concluded by mentioning the da Vinci system (Intuitive Surgical), which has been used for anterior access to the lumbar spine [Beutler et al. \u003Cem\u003ESpine (Phila Pa 1976)\u003C\/em\u003E. 2013]. However, its utility for spinal applications has not yet been demonstrated in a prospective study.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EEric A. Potts, MD, Indiana University, Indianapolis, Indiana, USA, concluded the session by addressing the use of powered and automated instruments for spine surgery. Spine surgeons can develop injuries associated with repetitive movements [Auerbach JD et al. \u003Cem\u003ESpine (Phila Pa 1976)\u003C\/em\u003E. 2011] that can lead to missed work or early retirement.\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EPowered and automated instruments can result in improved accuracy, shorter operative times, and reduced radiation exposure. Dr Potts noted that it is relatively easy to translate skills into working with power equipment and that anecdotal data are encouraging. In the longer term, it may be possible to develop replacements for tactile feel.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/50\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzltkd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzltkd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}