To our knowledge, this is the first single-center study to compare the use of the CIRQ ® Robotic Alignment to standard C-arm fluoroscopy-guided pedicle screw placement during instrumentation of the thoracolumbar spine.Ī consecutive series of instrumented thoracolumbar spine cases was queried from a prospectively maintained database of a single surgeon cases (SKD). The Cirq received FDA clearance in September 2019 however literature regarding its use still remains limited in comparison with other available systems. There are currently eight robotic systems approved in the United States by the FDA for spine surgery at the time this manuscript was written including: four iterations of Mazor (Mazor Robotics Inc, Caesarea, Israel), two of the ROSA (Zimmer Biomet, Warsaw, Indiana), ExcelsiusGPS (Globus Medical Inc, Audubon, Pennsylvania), and the Brainlab Cirq (Munich, Germany). Coordination of robotic surgical navigation with intraoperative computerized tomography (iCT) has improved the positional accuracy of pedicle screw placement reduced operating room staff exposure to ionizing radiation and may reduce physician musculoskeletal fatigue that could occur with multilevel constructs. Spinal robotic surgery is being adopted in the United States with greater frequency even outside tertiary care academic centers at the community level. Thoracolumbar screws inserted using C-arm fluoroscopy utilize less total operating room time with similar accuracy compared with the Cirq robotic assistance device. Nonetheless there were also more hospital readmissions in the Cirq cohort compared with the C arm group (p = 0.04). While total OR time was longer in the Cirq cohort by 123 min (p = 0.04), actual procedural time was not statistically different (p = 0.11). There were no misplaced pedicle screws in either group. Two thirds the patients had traumatic diagnoses with remaining degenerative spine disease. Forty percent were placed using the Cirq. ResultsĪ total of 166 screws were placed during the study period. Demographic information, diagnosis, total OR time, intraoperative complications, unexpected return to the operating room, and hospital readmissions within 90 days was compared between the two cohorts. Remaining two centers used C-arm fluoroscopy. One center took delivery of the Cirq robotic assistance device. We prospectively collected data of patients undergoing pedicle screw instrumentation in the thoracolumbar spine performed by a single surgeon at three different centers. To compare our experience with pedicle screw insertion of the thoracolumbar spine utilizing the Cirq robot assistance device compared with traditional paradigm using fluoroscopy.
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