Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery
Aims: Computer-navigated spinal instrumentation requires placement of a dynamic reference base (DRB), typically intraosseously in the ilium via a percutaneous stab incision on the posterior superior iliac spine (PSIS) entry point. Data describing the accuracy and complications of DRB placement are...
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The British Editorial Society of Bone & Joint Surgery
2025-05-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0006.R1 |
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| author | Joseph J. Y. Wan Qing H. Tan Dalun Leong Zhihong Chew Terry H. L. Teo |
| author_facet | Joseph J. Y. Wan Qing H. Tan Dalun Leong Zhihong Chew Terry H. L. Teo |
| author_sort | Joseph J. Y. Wan |
| collection | DOAJ |
| description | Aims: Computer-navigated spinal instrumentation requires placement of a dynamic reference base (DRB), typically intraosseously in the ilium via a percutaneous stab incision on the posterior superior iliac spine (PSIS) entry point. Data describing the accuracy and complications of DRB placement are limited in the literature. The aim of this study is to measure the accuracy of DRB placement in the PSIS, determine its exact placement trajectory, and determine the prevalence of related complications. Methods: This is a single-centre, institutional board approved, multisurgeon retrospective analysis of 69 included DRB placements from 51 robot-assisted lumbar posterior instrumentation procedures between May 2022 and April 2024. Pin entry point and trajectory were mapped out; the intraoperative O-arm CT scans and skin-to-PSIS depth were also measured, and patient demographics (age, sex, BMI), surgical outcomes, and postoperative complications were recorded. Results: Of the 69 PSIS pin placements, 47 (68.1%) had the correct entry point on the PSIS, and 35 (50.7%) of them were placed correctly within the ilium without breaching a second cortex. Skin-to-PSIS depth was significantly higher in patients with misplaced DRB placement, while age, sex, and BMI were similar. Of those with misplaced DRB (n = 34), one had delayed pin site wound healing. Conclusion: Percutaneous PSIS DRB placement has poor accuracy, with skin-to-PSIS depth being a significant factor. To avoid complications from misplaced DRB placement, the authors recommend the use of DRB placement on the iliac wing, or on the PSIS, following the trajectory used in pelvis posterior column fracture fixation, using fluoroscopy intraoperatively to ensure the DRB pin position. Cite this article: Bone Jt Open 2025;6(5):528–534. |
| format | Article |
| id | doaj-art-8b99bfc474cd46eeba87d3c80de68ff2 |
| institution | DOAJ |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-8b99bfc474cd46eeba87d3c80de68ff22025-08-20T03:09:51ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-05-016552853410.1302/2633-1462.65.BJO-2025-0006.R1Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgeryJoseph J. Y. Wan0Qing H. Tan1Dalun Leong2Zhihong Chew3Terry H. L. Teo4 Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore Aims: Computer-navigated spinal instrumentation requires placement of a dynamic reference base (DRB), typically intraosseously in the ilium via a percutaneous stab incision on the posterior superior iliac spine (PSIS) entry point. Data describing the accuracy and complications of DRB placement are limited in the literature. The aim of this study is to measure the accuracy of DRB placement in the PSIS, determine its exact placement trajectory, and determine the prevalence of related complications. Methods: This is a single-centre, institutional board approved, multisurgeon retrospective analysis of 69 included DRB placements from 51 robot-assisted lumbar posterior instrumentation procedures between May 2022 and April 2024. Pin entry point and trajectory were mapped out; the intraoperative O-arm CT scans and skin-to-PSIS depth were also measured, and patient demographics (age, sex, BMI), surgical outcomes, and postoperative complications were recorded. Results: Of the 69 PSIS pin placements, 47 (68.1%) had the correct entry point on the PSIS, and 35 (50.7%) of them were placed correctly within the ilium without breaching a second cortex. Skin-to-PSIS depth was significantly higher in patients with misplaced DRB placement, while age, sex, and BMI were similar. Of those with misplaced DRB (n = 34), one had delayed pin site wound healing. Conclusion: Percutaneous PSIS DRB placement has poor accuracy, with skin-to-PSIS depth being a significant factor. To avoid complications from misplaced DRB placement, the authors recommend the use of DRB placement on the iliac wing, or on the PSIS, following the trajectory used in pelvis posterior column fracture fixation, using fluoroscopy intraoperatively to ensure the DRB pin position. Cite this article: Bone Jt Open 2025;6(5):528–534.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0006.R1psisrobot spine surgeryminimally invasive spine surgeryintraoperative navigationspinal navigationreference framecomplicationssurgical techniquespinespine surgerypelvisct scanso-armbmiiliumspinal instrumentationsfracture fixationpostoperative complications |
| spellingShingle | Joseph J. Y. Wan Qing H. Tan Dalun Leong Zhihong Chew Terry H. L. Teo Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery Bone & Joint Open psis robot spine surgery minimally invasive spine surgery intraoperative navigation spinal navigation reference frame complications surgical technique spine spine surgery pelvis ct scans o-arm bmi ilium spinal instrumentations fracture fixation postoperative complications |
| title | Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery |
| title_full | Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery |
| title_fullStr | Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery |
| title_full_unstemmed | Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery |
| title_short | Accuracy of posterosuperior iliac spine reference array placement in robot-navigated spine surgery |
| title_sort | accuracy of posterosuperior iliac spine reference array placement in robot navigated spine surgery |
| topic | psis robot spine surgery minimally invasive spine surgery intraoperative navigation spinal navigation reference frame complications surgical technique spine spine surgery pelvis ct scans o-arm bmi ilium spinal instrumentations fracture fixation postoperative complications |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0006.R1 |
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