A NEW SURGICAL POSITIONING SYSTEM FOR ROBOTIC ASSISTED MINIMALLY INVASIVE SPINE SURGERY AND TRANSPEDICULAR APPROACH TO THE DISC

Abstract

Minimally Invasive Spine Surgery (MISS) procedures for the treatment of spinal pathologies haveexperienced exponential growth due to improved techniques and decreased trauma to the patient. SeveralMISS procedures that require the use of a trans-pedicular cannula as a guiding tool for pedicle screwplacement, delivery of biomaterials to the vertebral body or injection of biologics to the disc space havebeen described. Although these are clear advantages of MISS, the limited dissection and exposure mayreduce the accuracy and stability of operation and make spine surgeons rely heavily on intraoperativefluoroscopy, raising concerns over the level of radiation exposure. Robot-assisted minimal invasive surgeryhas aroused more attention for its high precision and stability, minimizing risks of damage to neurovascularstructures and diminishing harmful exposure to ionizing radiation. The aim of this paper is to describe andcharacterize a new surgical positioning system for for robotic assisted MISS. The system is conceived to beintegrated in a surgical platform capable of supporting the surgeon in a new procedure to treat degenerativeintervertebral disc disease. For this purpose, it is necessary to orientate a cannula in order to guide thebone drill along a planned route, to access the intervertebral disc through the pedicle and endplate. Inparticular, we describe a mechanism that percutaneously guides a cannula towards the intervertebral discbased on the acquisition of few fluoroscopic images. The design of the positioning system, with its featuresand constrains imposed by the presence of instrumentation and medical staff in the operating room, as wellas the software for trajectory planning during surgery, are here described.