TPS23x31-2|03.10.19-11:30 TPS23x31-2|03.10.19-11:30 TPS23x31-2|03.10.19-11:30 Navigation and Robotics in Spine Surgery Alexander R. Vaccaro, MD, PhD, MBA Richard H. Rothman Professor and Chairman Department of Orthopaedic Surgery Professor of Neurosurgery Thomas Jefferson University and Hospitals President The Rothman Institute Philadelphia, Pennsylvania, USA Jaykar R. Panchmatia, MA, MPH, MB BChir, FRCS Consultant Spine Surgeon Guy’s and St. Thomas’ Hospitals London, United Kingdom I. David Kaye, MD Assistant Professor of Orthopaedic Surgery Thomas Jefferson University and Hospitals Spine Surgeon The Rothman Institute Philadelphia, Pennsylvania, USA Srinivas K. Prasad, MD, MS Associate Professor of Neurological Surgery Director, Neurosurgical Spine Fellowship Thomas Jefferson University and Hospitals Philadelphia, Pennsylvania, USA 125 illustrations Thieme New York (cid:129) Stuttgart (cid:129) Delhi (cid:129) Rio de Janeiro TPS23x31-2|03.10.19-11:30 LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoingcontinual development.Researchandclinicalexperiencearecontinuallyexpandingour Names:Vaccaro,AlexanderR.,editor.|Panchmatia,JaykarR.,editor. knowledge,inparticularourknowledgeofpropertreatmentanddrugtherapy. | Kaye,I.David,editor.|Prasad,SrinivasK.,editor. Insofarasthisbook mentionsany dosageorapplication,readersmayrest Title:Navigationandroboticsinspinesurgery/[editedby]AlexanderR.Vaccaro, assuredthattheauthors,editors,andpublishershavemadeeveryeffortto JaykarR.Panchmatia,I.DavidKaye,SrinivasK.Prasad. ensurethatsuchreferencesareinaccordancewiththestateofknowledgeat Description:NewYork:Thieme,[2020]|Includesbibliographicalreferencesand index.|Summary:“Thepastdecadehasseenmajoradvancesinimage-guided thetimeofproductionofthebook. Nevertheless, this does not involve, imply, or express any guarantee or spinesurgerytechniques,withroboticallyassistedapproachesemerginginthe lastfiveyears.Whileearlyadoptersofthistechnologypavedthewayformore responsibilityonthepartofthepublishersinrespecttoanydosageinstructions andformsofapplicationsstatedinthebook.Everyuserisrequestedtoexamine widespreaduseofnavigatedandroboticsystems,barriersstillexist.Navigation carefullythemanufacturers’leafletsaccompanyingeachdrugandtocheck,if andRoboticsinSpineSurgerybymasterspinesurgeonAlexanderVaccaroand necessaryinconsultationwithaphysicianorspecialist,whetherthedosage esteemed co-editors Jaykar Panchmatia, David Kaye, and Srinivas Prasad schedulesmentionedthereinorthecontraindicationsstatedbythemanufac- addressesexistingissuessuchastheperceptionofincreasedupfrontcosts, intrusiononcurrentworkflow,andalackofunderstandingaboutthepotential turersdifferfromthestatementsmadeinthepresentbook.Suchexaminationis particularlyimportantwithdrugsthatareeitherrarelyusedorhavebeennewly waysthesetechnologiescanenhancethesurgicalexperienceandimprove releasedonthemarket.Everydosagescheduleoreveryformofapplicationusedis patientoutcomes.Organizedintosixsections,thebookstartswithevidence- entirelyattheuser’sownriskandresponsibility.Theauthorsandpublishers basedfundamentalsofnavigatedspinesurgeryandroboticsincludingdiscus- requesteveryusertoreporttothepublishersanydiscrepanciesorinaccuracies sion of instrumentation and mechanics. Sections 2-5 serve as a surgical noticed.Iferrorsinthisworkarefoundafterpublication,erratawillbepostedat handbookforspinesurgeonswhowishtointroducethesetechnologiesinto www.thieme.comontheproductdescriptionpage. practiceoraugmenttheircurrentrepertoirewithmorecomplextechniques. Someoftheproductnames,patents,andregistereddesignsreferredtointhis Topicsrangefrommoreroutineproceduressuchasnavigatedandrobotic bookareinfactregisteredtrademarksorproprietarynameseventhoughspecific minimallyinvasiveTLIFtocomplexapproacheslikeintraoperativeultrasound guidedintraduralspinaltumorresection.Thefinalsectionlooksatfuture referencetothisfactisnotalwaysmadeinthetext.Therefore,theappearanceofa namewithoutdesignationasproprietaryisnottobeconstruedasarepresen- directionsandpotentialnewapplicationsforthesetechnologies.KeyHigh- tationbythepublisherthatitisinthepublicdomain. lightsAnimpressivegroupof internationalspinesurgeonswhopioneered navigationandroboticsurgerytechniquesshareinvaluabletricksofthetrade Discussionoffluoroscopy-andintraoperativeCT-basedplatforms,applications forintraoperativesonography,andradiationexposureandminimizationstrat- egiesSpecialtopicsincludeORset-upandworkflow,surmountingthelearning curve,artificialintelligence,andlessonslearnedfromotherindustries”–Pro- videdbypublisher. Identifiers:LCCN2019033234|ISBN9781684200313(hardback) |ISBN9781684200320(eISBN) Subjects:MESH:Spine–surgery|SpinalDiseases–surgery|Spinal Injuries–surgery|RoboticSurgicalProcedures–methods Classification:LCCRD768|NLMWE727|DDC617.5/6059–dc23 LCrecordavailableathttps://lccn.loc.gov/2019033234 Copyright©2020byThiemeMedicalPublishers,Inc. ThiemePublishersNewYork 333SeventhAvenue,NewYork,NY10001USA +18007823488,[email protected] ThiemePublishersStuttgart Rüdigerstrasse14,70469Stuttgart,Germany +49[0]7118931421,[email protected] ThiemePublishersDelhi A-12,SecondFloor,Sector-2,Noida-201301 UttarPradesh,India +911204556600,[email protected] ThiemeRevinterPublicaçõesLtda. RuadoMatoso,170–Tijuca RiodeJaneiroRJ20270-135-Brasil +55212563-9702 www.thiemerevinter.com.br Coverdesign:ThiemePublishingGroup TypesettingbyThomsonDigital,India PrintedintheUnitedStatesofAmericaby KingPrintingCo.,Inc. 54321 Thisbook,includingallpartsthereof,islegallyprotectedbycopyright.Anyuse, ISBN978-1-68420-031-3 exploitation,orcommercializationoutsidethenarrowlimitssetbycopyright legislation,withoutthepublisher’sconsent,isillegalandliabletoprosecution. Alsoavailableasane-book: Thisappliesinparticulartophotostatreproduction,copying,mimeographing, eISBN978-1-68420-032-0 preparationofmicrofilms,andelectronicdataprocessingandstorage. TPS23x31-2|03.10.19-11:30 Iwouldliketodedicatethisbooktothefiguresinmylifewhoservedasmentors,innovators, andmostimportantlyastruefriendsinguidingmylife’sjourney: JerryCotler,StevenGarfin,andRichardRothman. —AlexanderR.Vaccaro Idedicatethisbooktomyparents,forprovidingmewithastrongfoundationforlife;tomywife, forinspiringmetobuildonthatfoundation;andtomysons,formakingitallworthwhile. —JaykarR.Panchmatia ThisbookisdedicatedtomylovingwifeTalya,whohasbeentherewithandformefromthestart,and ourchildrenOlivia,Jordyn,andMattie,whopushedforachapteraboutTransformersbutsettled forabookaboutspinesurgery. —I.DavidKaye Tomyparents,RathnaandMaheswaraPrasad,fortheirdecadesoftirelesslove,support, andsacrifice.Tomywife,Gita,andmykids,KrishnaandLeela,whogivemy lifemeaninganddefinemyeveryday. —SrinivasK.Prasad TPS23x31-2|03.10.19-11:30 NavigationandRoboticsinSpineSurgery|03.10.19-11:00 Contents Foreword.......................................................................................... xi Preface............................................................................................ xii Contributors...................................................................................... xiv PartIIntroductiontoNavigationandRobotics 1 PrinciplesofNavigatedPedicleScrewPlacement ............................................ 2 YusefI.MosleyandSrinivasK.Prasad 2 Three-DimensionalComputer-AssistedNavigationPlatforms............................... 7 BarrettS.Boody 3 IntraoperativeUltrasoundinSpineSurgery:AVersatileandUsefulAdjunct .............. 11 RalphT.Schär,HowardJ.Ginsberg,andJeffersonR.Wilson 4 MagneticResonanceImaging–BasedNavigation............................................. 18 JonathanG.SeaveyandLangstonT.Holly 5 SharedControlRobotics......................................................................... 24 ElvisL.FrancoisandArjunS.Sebastian 6 TelesurgicalRobots.............................................................................. 28 KyleW.MombellandPatrickB.Morrissey 7 Supervisory-ControlledRobotics............................................................... 32 SohrabPahlavanandNathanH.Lebwohl 8 RadiationExposureandNavigatedSpinalSurgery ........................................... 34 ScottC.Wagner PartIITechniquesforNavigation-AssistedSpineSurgery 9 OutcomesinNavigatedSpinalSurgery........................................................ 38 BrianT.Sullivan,AlexA.Johnson,NicholasTheodore,JeffJacobson,andA.JayKhanna 10 NavigatedSubaxialCervicalSpinePedicleScrewInstrumentation ......................... 45 JohnA.BuzaIIIandPeterG.Passias 11 NavigatedAnteriorTransoralSurgeryforC1andC2Pathologies........................... 51 ChristineL.HammerandJamesJ.Evans 12 NavigatedPosteriorCorrectionofPediatricScoliosis........................................ 59 JustinC.Paul,AryaVarthi,andRajJ.Gala 13 NavigatedPosteriorInstrumentationoftheArthrodesedSpine............................ 68 ErikaA.Dillard,JamesS.Harrop,andI.DavidKaye 14 NavigatedMinimallyInvasiveTransforaminalLumbarInterbodyFusion................... 76 BradleyC.JohnsonandThomasJ.Errico vii NavigationandRoboticsinSpineSurgery|03.10.19-11:00 Contents 15 RoboticInstrumentationforLumbosacralSpondylolisthesis................................. 82 MichaelR.ContiMica,MichaelP.Silverstein,R.AldenMilamIV,andEricB.Laxer 16 TheRoleofNavigationintheResectionofPrimarySpinalTumor........................... 87 TaolinFang,JianDong,andStefanoBoriani 17 SurgicalManagementofThoracolumbarSpinalMetastasesUsingNavigation............. 96 ZachPennington,A.KarimAhmed,CamiloA.Molina,andDanielM.Sciubba 18 NavigatedPelvicFixation ........................................................................ 111 HarukiFunao,BrianJ.Neuman,andKhaledM.Kebaish 19 NavigatedSacroiliacJointFusion................................................................ 116 WesleyH.BronsonandJoshuaE.Heller 20 NavigationBalloonKyphoplasty ................................................................ 122 RichardM.McEntee,KaitlynVotta,andI.DavidKaye PartIIITechniquesforRobotic-AssistedSpineSurgery 21 OutcomesinRoboticSpinalSurgery............................................................ 128 GlennS.Russo,ChristopherM.Bono,andJamesD.Kang 22 RoboticSubaxialCervicalSpinePedicleScrewInstrumentation............................. 131 WeiTian,MingxingFan,JingweiZhao,andYajunLiu 23 NavigatedandRoboticAnteriorOdontoidPegFractureFixation............................ 135 KartikShenoyandAliBydon 24 NavigatedandRoboticPosteriorAtlantoaxialFusion......................................... 140 AndrewH.MilbyandJamesM.Schuster 25 RoboticPosteriorThoracicPedicleScrewPlacement ......................................... 148 MarcoC.Mendoza,R.AldenMilamIV,andEricB.Laxer 26 RoboticMinimallyInvasiveTransforaminalLumbarInterbodyFusion ...................... 153 AlfredJ.PisanoandDonaldF.ColantonioIII 27 RoboticAnteriorLumbarInterbodyFusion .................................................... 160 PatriciaZadnikSullivan,TristanBlaseFried,andWilliamC.Welch PartIV TechniquesUsingAlternativeModalitiesforComplexSpinePathology 28 IntraoperativeUltrasound-GuidedIntraduralTumorResection.............................. 164 YamaanS.Saadeh,JayK.Nathan,andMarkE.Oppenlander 29 StereotacticRadiosurgeryforTreatmentofPrimaryandMetastaticSpinalTumors....... 170 OriBarzilai,AdamM.Schmitt,MarkH.Bilsky,andIlyaLaufer PartVEasingtheTransitiontoTechnologicalAdoption 30 OperatingRoomDesignandEfficiency......................................................... 178 JamesDowdell,ChristopherM.Mikhail,andAndrewC.Hecht viii NavigationandRoboticsinSpineSurgery|03.10.19-11:00 Contents 31 MountingtheLearningCurvewithNewTechnologies....................................... 185 JohnE.Ziewacz PartVIFutureDirections 32 ArtificialIntelligence............................................................................. 190 JaykarR.PanchmatiaandTrishanPanch 33 WhatWeCanLearnfromOtherIndustries.................................................... 195 NikolaKocovicandI.DavidKaye 34 FutureGrowthinNavigatedandRoboticSpinalSurgery .................................... 203 DarianR.Esfahani,PrateekKumar,KimberlyHu,ZacharyTan,BrandonL.Neisewander,andAnkitI.Mehta Index .............................................................................................. 209 ix