Abstract
The study design is retrospective, multi-surgeon, single-center review. The objective is to evaluate complication rates, revision rates, and accuracy grading for robotic-guided S2 alar-iliac (S2AI) screws. Sixty-five consecutive patients underwent S2AI fixation (118 screws) as part of a posterior spine fusion using robotic-guidance. Screws were placed percutaneously in 14 cases and 51 were placed in an open fashion by three board-certified spine surgeons using the Mazor core technology robotic systems (Mazor X, n = 42; Mazor XSE, n = 23). Medical charts were retrospectively reviewed for revisions and complications. All patients were followed for 90 days or greater. Postoperative CT scans were obtained in 22 of the 51 patients, allowing for 46 screws to be reviewed by an independent neuroradiologist who graded the screws for accuracy. There were no intraoperative or postoperative complications associated with S2AI screw placement. There were no revisions found to be related to the S2AI screw placement. All 46 screws evaluated with postoperative CT scans were reported as being at the highest level of accuracy, grade A, with a breach distance of 0 mm (no breach). The robotic-guided technique for S2AI screw placement is a reliable method to achieving pelvic fixation with low complication and revision rates. In addition, a high degree of accuracy can be achieved without relying on visible and tactile landmarks needed for the freehand technique or the additional radiation associated with fluoroscopic-guidance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jazini E, Klocke N, Tannous O, Johal H, Hao J, Salloum K, Gelb D, Nascone J, Belin E, Hoshino CM, Hussain M, O'Toole R, Bucklen B, Ludwig SC (2017) Does lumbopelvic fixation add stability? A cadaveric biomechanical analysis of an unstable pelvic fracture model. J Orthop Trauma 31(1):37–46
Laratta JL, Shillingford JN, Lombardi JM, Alrabaa RG, Benkli B, Fischer C, Lenke LG, Lehman RA (2018) Accuracy of S2 alar-iliac screw placement under robotic guidance. Spine Deform 6(2):130–136
Shillingford JN, Laratta JL, Park PJ, Lombardi JM, Tuchman A, Saifi C, Lehman RA, Lenke LG (2018) Human versus robot: a propensity-matched analysis of the accuracy of free hand: versus: Robotic Guidance for Placement of S2 Alar-Iliac (S2AI) Screws. Spine 43(21):E1297–E1304
Laratta JL, Shillingford JN, Meredith JS, Lenke LG, Lehman RA, Gum JL (2018) Robotic versus freehand S2 alar iliac fixation: in-depth technical considerations. J Spine Surg 4(3):638
Shillingford JN, Laratta JL, Tan LA, Sarpong NO, Lin JD, Fischer CR, Lehman RA, Yongjung J, Lenke LG (2018) The free-hand technique for S2-alar-iliac screw placement: a safe and effective method for sacropelvic fixation in adult spinal deformity. JBJS 100(4):334–342
Chang TL, Sponseller PD, Kebaish KM, Fishman EK (2009) Low profile pelvic fixation. Spine 34(5):436–440. https://doi.org/10.1097/BRS.0b013e318194128c
Allen BL Jr, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9:388–394
von Glinski A, Yilmaz E, Ishak B, Ramey W, Jack A, Iwanaga J, Abdul-Jabbar A, Oskouian RJ, Tubbs RS, Chapman JR (2020) Neurovascular relations in modified iliac screws and traditional iliac screw: anatomic study. World Neurosurg 134:e93–e97
Fridley J, Fahim D, Navarro J, Wolinsky JP, Omeis I (2014) Free-hand placement of iliac screws for spinopelvic fixation based on anatomical landmarks: technical note. Int J Spine Surg 8:3
Jazini E et al (2017) Outcomes of lumbopelvic fixation in the treatment of complex sacral fractures using minimally invasive surgical techniques. Spine J 17(9):1238–1246
Peelle MW, Lenke LG, Bridwell KH, Sides B (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws. Spine 31(20):2392–2398. https://doi.org/10.1097/01.brs.0000238973.13294.16
Mattei TA, Fassett DR (2013) Low-profile pelvic fixation with sacral alar-iliac screws. Acta Neurochir 155(2):293–297
Unoki E, Miyakoshi N, Abe E, Kobayashi T, Abe T, Kudo D, Shimada Y (2019) Sacropelvic fixation with S2 Alar Iliac screws may prevent sacroiliac joint pain after multisegment spinal fusion. Spine 44(17):E1024–E1030
Hyun SJ, Kim KJ, Jahng TA (2017) S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients. Eur Spine J 26(8):2198–2203
Elder BD, Ishida W, Lo SF, Holmes C, Goodwin CR, Kosztowski TA, Bydon A, Gokaslan ZL, Wolinsky JP, Sciubba DM, Witham TF (2017) Use of S2-Alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine 42(3):E142–E149. https://doi.org/10.1097/BRS.0000000000001722
O’Brien JR, Yu W, Kaufman BE, Bucklen B, Salloum K, Khalil S, Gudipally M (2013) Biomechanical evaluation of S2 Alar-Iliac screws. Spine 38(20):E1250–E1255. https://doi.org/10.1097/BRS.0b013e31829e17ff
Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15(1):11–14. https://doi.org/10.1097/00007632-199001000-00004
Hu X, Lieberman IH (2017) Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy. Eur Spine J 26(3):720–725
O’Brien JR, Matteini L, Warren DY, Kebaish KM (2010) Feasibility of minimally invasive sacropelvic fixation. Spine 35(4):460–464. https://doi.org/10.1097/BRS.0b013e3181b95dca
Zhang J et al (2009) Dosimetric characterization of a cone-beam O-armTM imaging system. J X-Ray Sci Technol 17(4):305–317. https://doi.org/10.3233/XST-2009-0231
Funding
Medtronic.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
CRG has received consulting fees from K2M/Stryker, Medtronic, and Mazor and is on an advisory board for Stryker, Augmedics, Medtronic, has received royalties from K2M/Stryker, Medtronic and has stock in Augmedics and NSite. EJ has received consulting fees from Stryker and Precision Spine. CMH has received consulting fees from Globus Medical, and Spineart. LDO, AET, TCS, FRB, DB, KMG, and RR have no other conflicts of interest to declare.
Ethical approval
This study was approved by a centralized IRB, Advarra, on May 16th (Pro00042720). This study was conducted in accordance with the 1964 Helsinki Declaration, its amendments, and other equivalent ethical standards. All study participants or their legally authorized representative signed written informed consent, included in the Notice of Privacy Practices, for study enrollment and publication prior to surgery.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Good, C.R., Orosz, L.D., Thomson, A.E. et al. Robotic-guidance allows for accurate S2AI screw placement without complications. J Robotic Surg 16, 1099–1104 (2022). https://doi.org/10.1007/s11701-021-01345-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-021-01345-x