Institutional members access full text with Ovid®

Share this article on:

Robot-Assisted Vertebral Body Augmentation: A Radiation Reduction Tool

Barzilay, Yair MD*; Schroeder, Josh E. MD*; Hiller, Nurith MD; Singer, Gordon MD*; Hasharoni, Amir MD, PhD*; Safran, Ori MD*; Liebergall, Meir MD*; Itshayek, Eyal MD; Kaplan, Leon MD*

doi: 10.1097/BRS.0000000000000100

Study Design. Retrospective.

Objective. To assess radiation exposure time during robot-guided vertebral body augmentation compared with other published findings.

Summary of Background Data. Rising incidence of vertebral compression fractures in the aging population result in widespread use of vertebral body cement augmentation with significant radiation exposure to the surgeon, operating room staff, and patient. Radiation exposure leads to higher cancer rates among orthopedic and spine surgeons and patients.

Methods. Thirty-three patients with 60 vertebral compression fractures underwent robot-guided vertebral body augmentation performed by 2 surgeons simultaneously injecting cement at 2 levels under pulsed fluoroscopy. The age of patients was in the range from 29 to 92 (mean, 67 yr). One to 6 vertebrae were augmented per case (average 2). Twenty-five patients had osteoporotic fractures and 8 had pathological fractures. Robotic guidance data included execution rate, accuracy of guidance, total surgical time, and time required for robotic guidance. Radiation-related data included the average preoperative computed tomographic effective dose, radiation time for calibration, registration, placement of Kirschner wires, and total procedure radiation time. Radiation time per level and surgeon's exposure were calculated.

Results. Kyphoplasty was performed in 15 patients (1 sacroplasty), vertebroplasty in 13, and intravertebral expanding implants in 5. The average preoperative computed tomographic effective dose was 50 mSv (18–81). Average operative time was 118 minutes (49–350). Mean robotic guidance took 36 minutes. Average operative radiation time was 46.1 seconds per level (33–160). Average exposure time of the surgeons and the operating room staff per augmented level was 37.6 seconds. The execution rate was 99%, with an accuracy of 99%. Two complications (hemothorax and superficial wound infection) occurred.

Conclusion. The radiation exposure of the surgeon and the operating room staff in a series of robot-assisted vertebral body augmentation was 74% lower than published results on fluoroscopy guidance and approximately 50% lower than the literature on navigated augmentation.

Level of Evidence: 4

Vertebral cement augmentation is associated with up to 10 minutes of fluoroscopy per level. Orthopedic surgeons' cancer risk is 5.37 higher than the general population. A series of robot-guided vertebral augmentation was compared with published results on freehand and navigated augmentation. In robot-guided augmentation, fluoroscopy time was 50% lower than navigated augmentation and 74% lower than fluoroscopy guidance.

*Departments of Orthopedic Surgery

Radiology; and

Neurosurgery, Hadassah-Hebrew-University Medical Center, Jerusalem, Israel.

Address correspondence and reprint requests to Yair Barzilay, MD, Spine unit, Department of Orthopedic Surgery, Hadassah-Hebrew-University Medical Center, Jerusalem, Israel; E-mail:

Acknowledgment date: November 15, 2011. First revision date: February 18, 2013. Second revision date: April 28, 2013. Acceptance date: July 26, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, patents, royalties, stocks, travel/accommodations/meeting expenses, payment for lecture, grants.

© 2014 by Lippincott Williams & Wilkins