Robot-assisted intravertebral augmentation corrects local kyphosis more effectively than a conventional fluoroscopy-guided technique

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Intravertebral augmentation (IVA) is a reliable minimally invasive technique for treating Magerl type A vertebral body fractures. However, poor correction of kyphotic angulation, the risk of cement leakage, and significant exposure to radiation (for the surgeon, the operating room staff, and the patient) remain significant issues. The authors conducted a study to assess the value of robot-assisted IVA (RA-IVA) for thoracolumbar vertebral body fractures.


The authors performed a retrospective, single-center study of patients who had undergone RA-IVA or conventional fluoroscopy-guided IVA (F-IVA) for thoracolumbar vertebral body fractures. Installation and operating times, guidance accuracy, residual local kyphosis, degree of restoration of vertebral body height, incidence of cement leakage, rate of morbidity, length of hospital stay, and radiation-related data were recorded.


Data obtained in 30 patients who underwent RA-IVA were compared with those obtained in 30 patients who underwent F-IVA during the same period (the surgical indications were identical, but the surgeons were different). The mean ± SD installation time in the RA-IVA group (24 ± 7.5 minutes) was significantly shorter (p = 0.005) than that in the F-IVA group (26 ± 8 minutes). The mean operating time for the RA-IVA group (52 ± 11 minutes) was significantly longer (p = 0.026) than that for the F-IVA group (30 ± 11 minutes). All RA-IVAs and F-IVAs were Ravi’s scale grade A (no pedicle breach). The mean degree of residual local kyphosis (4.7° ± 3.15°) and the percentage of vertebral body height restoration (63.6% ± 21.4%) were significantly better after RA-IVA than after F-IVA (8.4° ± 5.4° and 30% ± 34%, respectively). The incidence of cement leakage was significantly lower in the RA-IVA group (p < 0.05). The mean length of hospital stay after surgery was 3.2 days for both groups. No surgery-related complications occurred in either group. With RA-IVA, the mean radiation exposure was 438 ± 147 mGy × cm for the patient and 30 ± 17 mGy for the surgeon.


RA-IVA provided better vertebral body fracture correction than the conventional F-IVA. However, RA-IVA requires more time than F-IVA.

ABBREVIATIONS F-IVA = fluoroscopy-guided intravertebral augmentation; fpCT = flat-panel CT; IVA = intravertebral augmentation; LOS = length of hospital stay; NS = not significant; PMMA = polymethylmethacrylate; RA-IVA = robot-assisted IVA; VAS = visual analog scale.

Article Information

Correspondence Michel Lefranc: Amiens Picardie University Medical Center, Amiens, France.

INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.8.SPINE18197.

Disclosures Dr. Lefranc reports being a consultant for Zimmer Biomet.

© AANS, except where prohibited by US copyright law.



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    Sagittal CT scans obtained before and after surgery. Figure is available in color online only.

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    Illustration of the RA-IVA technique. A: The 3D trajectory for bilateral transpedicular K-wire placement is planned. B: A hole was drilled through each pedicle using real-time robotic guidance; the robot is able to track the movements of the patient’s body in real time. The K-wire was passed through the skin and the pedicle, and was then tapped into the anterior part of the vertebral body. C and D: Implant insertion/expansion and PMMA cement injection were guided by the fluoroscopy mode of the fpCT scanner. Figure is available in color online only.

  • View in gallery

    Illustration of K-wire insertion thanks to robotic assistance. The robot is placed along the planned trajectory. A reducer is placed along the trajectory with regard to the pedicle entry point. The K-wire is passed through the reducer through the skin and pedicle and is navigated into the anterior part of the vertebral body. Figure is available in color online only.



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