Introduction: Potential complications associated with screw malposition may result in neurological deficits or vascular injuries. Spine surgery has significantly developed under the assistance of technological progress. The advantages of applying robotic technology in spine surgery include the possibility of improving screw accuracy, reducing complications, decreasing fluoroscopy use.Areas covered: We critically evaluated the current literature on the radiographic and clinical outcomes of robotic-assisted spine surgery, including accuracy, radiation exposure, operative time, and complication rates.Expert opinion: Robotic-assisted spine surgery shows promising results and has the potentials for further investigations. The robot-assisted spine surgery is appeared to be more accurate in pedicle screw placement than the free-hand technique. In general, the robot-assisted technique is associated with shorter radiation exposure time but longer operative time than free-hand technique. For higher accuracy of robotic-assisted spine surgery, technical advancement and high-quality researches are needed. Artificial intelligent technology, decompression function, and higher accuracy are the directions for the development of robotic-assisted spine surgery.

Robotic navigation during spine surgery

Background Accurate insertion of pedicle screws in scoliosis patients is a great challenge for surgeons due to the severe deformity of thoracic and lumbar spine. Meanwhile, mal-position of pedicle screw in scoliosis patients could lead to severe complications. Computer-assisted navigation technique may help improving the accuracy of screw placement and reducing complications. Thus, this meta-analysis of the published researches was conducted concentrating on accuracy of pedicle screw placement and postoperative assessment in scoliosis patients using computer-assisted navigation technique. Methods PubMed, Cochrane and Web of Science databases search was executed. In vivo comparative studies that assessed accuracy and postoperative evaluation of pedicle screw placement in scoliosis patients with or without navigation techniques were involved and analysed. Results One published randomised controlled trial (RCT) and seven retrospective comparative studies met the inclusion criteria. These studies included 321 patients with 3821 pedicle screws inserted. Accuracy of pedicle screw insertion was significantly increased with using of navigation system, while average surgery time was not significantly different with non-navigated surgery. And Correction rate for scoliosis in navigated surgery was not significantly different with non-navigated surgery. Conclusions Navigation technique does indeed improve the accuracy of pedicle screw placement in scoliosis surgery, without prolong the surgery time or decrease the deformity correction effect.

Accuracy and post-operative assessment of pedicle screw placement in scoliosis surgery with computer-assisted navigation: a meta-analysis

Objectives The present study aimed to evaluate the status and trends of robotic orthopedic surgery in a clinical setting using bibliometrics. Methods All relevant publications on the clinical use of robotic surgery in orthopedics were searched from the Web of Science database. Subsequently, data were analyzed using bibliometrics. Visualizing data of bibliographic coupling, co-citation, and co-occurrence analysis were performed using VOSviewer. Results In total, 224 clinical studies met the included standards between 2000 to 2019. Global publications presented an increasing annual trend, with the United States found to have the largest number of publications and robotic companies active in the field (n = 99), followed by China (n = 38), and the United Kingdom (n = 27). The institution with the most contributions was the Beijing Jishuitan Hospital in China (n = 15). The most productive scholars were Tian Wei and Mont Michael A, with 14 publications each. The top 30 most cited papers list showed 29 publications to be cited on more than 40 occassions. The journal with the most related and influential publications on robotic orthopedic surgery was the Journal of Arthroplasty. Fourteen types of robots were used, with the majority applied in knee and spinal surgery. MAKO was the most widely used robot in hip and knee surgery and Mazor in spinal surgery. Most studies were small sample populations of low-quality in this field. The top 20 most frequently used keywords were identified from 950 author keywords. Research on orthopedic robots were classified into two clusters by co-occurrence networks: spinal-related robotic surgery and joint-related robotic surgery. Conclusions The present bibliometric study summarizes the clinical research of orthopedic robots on study type, sample size, type of surgery, robot information, surgical site, most popular keywords, most cited papers, journals, authors, institutions, and countries. These findings may assist the scholars better understand the current status and research trends to guide future practice and directions.

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Clinical application of robotic orthopedic surgery: a bibliometric study

There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult.The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery.Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed.We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons' needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021.

Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery.

Objective To compare the accuracy, efficiency, and safety of robotic assistance (RA) and conventional fluoroscopy guidance for the placement of C1 lateral mass and C2 pedicle screws in posterior atlantoaxial fusion. Methods The data of patients who underwent posterior C1–C2 screw fixation (Goel-Harm's technique) in our hospital from August 2014 to March 2021 were retrospectively evaluated, including 14 cases under fluoroscopic guidance and 11 cases under RA. The hospital records, radiographic results, surgical data, and follow-up records were reviewed. Accuracy of screw placement was assessed using the Gertzbein and Robbins scale, and clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), modified MacNab criteria, and postoperative complications. Results Baseline characteristics of both groups were similar. The mean estimated blood loss in the fluoroscopic guidance and RA groups was 205.7 ± 80.3 mL and 120.9 ± 31.9 mL, respectively (p = 0.03). The mean surgical duration was 34 min longer with RA compared to that performed with free-hand (FH) method (p = 0.15). In addition, lower intraoperative radiation exposure was detected in the RA group (12.4 ± 1.4 mGy/screw) versus the FH (19.9 ± 2.1 mGy/screw) group (p = 0.01). The proportion of “clinically acceptable” screws (graded 0 and I) was higher in the RA group (93.2%) than that in the FH group (87.5%, p = 0.04). There was no significant difference in the increase of JOA score and decrease of VAS score between the two surgical procedures. Furthermore, there were no significant differences in overall clinical outcome between the two groups and no neurovascular complications associated with screw insertion. Conclusions RA is a safe and potentially more accurate alternative to the conventional fluoroscopic-guided FH technique for posterior atlantoaxial internal fixation.

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Accuracy and Safety of Robot-Assisted versus Fluoroscopy-Guided Posterior C1 Lateral Mass and C2 Pedicle Screw Internal Fixation for Atlantoaxial Dislocation: A Preliminary Study

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwen...

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients:

The utility model discloses a directional activity brace of medical wrist joint comprises palm module, arm module, hinge chain union piece, fixed layering, nylon fastener tape area and fixed band, and the palm module is the oblate lasso of one side open -ended batter post shape, the fixed nylon fastener tape in both sides of top end opening department, the arm module is the L half -arc groove holds in the palm, the circular arc diameter from the meander at middle part before to the gradually little formation of one end the groove hold in the palm, to gradually big formations upper arm groove support of the other end, do two grooves form 70 between holding in the palm 90 the contained angle is fixed with the nylon fastener tape who has fixed layering on hold in the palm in the forearm groove, has the fixed band on hold in the palm in the upper arm groove, the forearm groove is held in the palm and to be passed through steel sheet syllogic hinge chain union piece with the palm module and be connected, constitutes the medical wrist joint brace that moves about The utility model discloses simple structure, convenient and practical wear comfortablely, accord with wrist joint postoperative dynamic and static combination rehabilitation training requirement, are suitable for popularization and application

Directional activity brace of medical wrist joint

A multi-position traction frame for medical wrist arthroscopy surgery is composed of a base plate, a retaining nut, a fixed base, a main stand column, an adjusting stand column, a connecting rod, a cross rod, a positioning pin, a fixed vertical plate, a locking nut, a lifting lead screw, locking hand wheels and a pinching sleeve. The fixed base is arranged on the plane of the rectangular base plate provided with support legs. End face teeth on the fixed base are matched with end face teeth of the main stand column and the connecting rod, and the fixed base is locked through the corresponding screw rotating hand wheel. The adjusting stand column is inserted into the cylindrical connecting rod, and the cylindrical connecting rod is locked through the corresponding rotating hand wheel. One end of the cross rod is sleeved with the top end of the adjusting stand column and is transversely fixed through the positioning pin, the lifting lead screw capable of moving transversely is perpendicularly installed at the other end of the cross rod, and the lifting lead screw is connected with the pinching sleeve. Three groups of through grooves are formed in the plane of the base plate, and the fixed vertical plate is installed in the through grooves. A paraxial structure which can be adjusted in multiple directions is adopted, the structure is stable, convenient to use, fast and reliable, and multi-position traction of the wrist joints of a patient and fluoroscopy and monitoring can be achieved easily during surgery.

Multi-position traction frame for medical wrist arthroscopy surgery

The utility model provides a medical wrist arthroscopic surgery multi -body position traction frame, by bottom plate, fixation nut, fixing base, head tree, adjustment stand, coupling lever, horizontal pole, shop bolt, fixed riser, locking screw, elevating screw, locking handwheel and pinch the cover and constitute. There is the fixing base on having the plane of the rectangle bottom plate of landing leg, the terminal surface tooth on the fixing base and the terminal surface tooth cooperation of head tree and coupling lever, by the rotatory hand wheel locking of screw, adjustment stand, rotatory hand wheel locking are gone into in the interpolation of drum coupling lever, adjustment stand top and transversely fixed by the shop bolt is emboliaed to horizontal pole one end, but lateral shifting elevating screw is installed perpendicularly to the other end, and elevating screw connects a pinch cover, be equipped with three groups on the bottom plate plane and lead to the groove, lead to the fixed riser of inslot installation. The utility model discloses a paraxonic structure that can multi -directionly adjust, stable in structure, convenient to use, swift reliable is convenient for to carry out the multi -body position at the operation in -process to patient's wrist joint and is drawn and carry out X line perspective and observe and the control.

Medical wrist arthroscopic surgery multi -body position traction frame

The utility model discloses a by the aseptic rubber protective sleeve of ke shi needle that protection sleeve body and ke shi cushion hand -hole constitute, short cylinder that protection sleeve body suppressed into for aseptic rubber mold, the cylinder both ends are the hemisphere end, and one section center is equipped with keshi cushion hand -hole along the axial in the end, the degree of depth to the protection sleeve body middle part of keshi cushion hand -hole, the diameter in hole is lighter than the foreign economic relations of keshi needle. The utility model discloses can be directly exposing the end with the ke shi needle in affected part and inserting keshi cushion on the protection sleeve body and go into downtheholely, the protection exposes the end and does not take place the position and move, and the keshi needle does not return sunkenly, reduces and seriously scrapes the mouth of damaging, makes bone surgery safer, and is swift. Simple structure, convenient to use, use cost is low, and is efficient, easily uses widely.

Tian Wei

Papers

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients:

Directional activity brace of medical wrist joint

Multi-position traction frame for medical wrist arthroscopy surgery

Medical wrist arthroscopic surgery multi -body position traction frame

Aseptic rubber protective sleeve of ke shi needle