Navigation and Robotics in Pediatric Spine Surgery

摘要

Navigation and robotics in pediatric spine surgery have evolved due to the desire for improved safety and efficiency of pedicle screw placement. Computer guided navigation for pedicle screw placement is based on instrument registration to three-dimensional imaging of the spine and relies on a surgeon’s ability to coordinate hand and instrument movements with a computerized screen representing the patient’s anatomy. Navigation has been shown to be associated with higher accuracy for pedicle screw placement than other modern techniques such as free hand or fluoroscopic screw guidance. The use of robotics in surgery emerged as a potential way to diminish human error and with navigation has evolved to become a potential state of the art technique for spine surgery. Robotic-assisted pedicle screw placement with real time navigation afford the surgeon efficient means of rigid trajectory guidance based on anatomical registration of the patient’s anatomy. Navigation, when coupled with robotics, aids the surgeon in confirmatory imaging on the screen in real time. While associated with significant set-up costs, a steep learning curve, and initial longer operating room times this technology promises to enhance accuracy and lead to a reduction in complications. Intraoperative pitfalls exist such as registration difficulties, intraoperative spine movement affecting accuracy, and instrument skiving. However, the benefits including improved surgical ergonomics and screw accuracy will undeniably continue to foster technological innovation to overcome the pitfalls, which will make robotics a standard part of pediatric spinal deformity surgery in the future.