Joint Kinematics of Surgeons during Lumbar Pedicle Screw Placement
Authors: Park J. Y. , Kuh S. U. , Cho Y. E. 
Published: May 2014

Introduction

Robotic spine surgery has been developed to improve spine surgery, especially the placement of pedicle screws recently. There have been no basic studies regarding the changes in joint angles and kinematics of surgeons during pedicle screw fixation. Understanding kinematics and joint movements of the surgeon during the placement of pedicle screws is essential to create an effective robot suitable for spinal surgery. The objective of this study is to assess the joint kinematics of the surgeon during the insertion of lumbar pedicle screws.

Materials and Methods

This is a cross-sectional study. We enrolled 18 experienced spine surgeons in this study, who each performed lumbar pedicle screw placement using a spine surgery simulator at the spinal level L3/4. To assess the movements of the surgeons, we used an optoelectronic motion analysis system with 16 cameras. A total of 20 markers were placed from the cervical spine to the pelvis (12 markers; C2, C4, C7, T6, L1, L3, PSIS x 2, ASIS x 2, Sacrum × 2), on both shoulders (2 markers; acromion), the right elbow (1 marker; olecranon), the right wrist (2 markers; ulna and radius styloid process), and the screw driver (3 markers; proximal handle × 1 and distal handle × 2). Using 3-dimentional motion images, distance changes in 5 joints (αB, body; αS, shoulder; αE, elbow; αW, wrist; and αI, instrument), and angle changes in 6 joints (αB, body; αS, shoulder; αE, elbow; αW, wrist; αI, instrument; and αP, pedicle) regarding X-, Y-, and Z-axes were calculated during pedicle screw placement. The distance and angle changes were measured at 8 setting points (L3/4 x Right/Left x Start/End) during pedicle screw placement and compared between joints.

Results

Whole joint distances and angles differed significantly according to setting points during pedicle screw placement. Fluctuations in distance increased gradually from the proximal joint (αB) to distal joint (αI; instrument) and the largest change was noted along the X-axis. Angle fluctuations were largest at the distal point (αP, pedicle) but did not gradually increase and the αE (elbow) showed the second largest fluctuation. Changes along the X-axis change were larger than those of the Y- and Z-axes.

Conclusion

The distances moved by whole joints gradually increased from proximal portions of the body to the hand, but in terms of angle changes, the elbow joint was the most dynamic during lumbar pedicle screw placement. Whole joints of surgeons carry out harmonic role during lumbar pedicle screw placement. Disclosure of Interest J. Y. Park: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) S. U. Kuh: None declared Y. E. Cho: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) References Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine 2007;32(3):E111-E120 Marcus HJ, Cundy TP, Nandi D, Yang GZ, Darzi A. Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J 2014;23(2):291–297 Lieberman IH, Togawa D, Kayanja MM, et al. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: Part I—Technical development and a test case result. Neurosurgery 2006;59(3):641-650, discussion 641–650 Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine 2010;35(24):2109–2115 Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 2011;20(6):860–868 Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus 2009;27(3):E9 Preuss RA, Popovic MR. Three-dimensional spine kinematics during multidirectional, target-directed trunk movement in sitting. J Electromyogr Kinesiol 2010;20(5):823–832 Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 2012;21(12):2704–2712 Rao SS, Bontrager EL, Gronley JK, Newsam CJ, Perry J. Three-dimensional kinematics of wheelchair propulsion. IEEE Trans Rehabil Eng 1996;4(3):152–160 Gronley JK, Newsam CJ, Mulroy SJ, Rao SS, Perry J, Helm M. Electromyographic and kinematic analysis of the shoulder during four activities of daily living in men with C6 tetraplegia. J Rehabil Res Dev 2PO.130;37(4):423–432 Wagner H, Tilp M, von Duvillard SP, Mueller E. Kinematic analysis of volleyball spike jump. Int J Sports Med 2009;30(10):760–765 Vickers DR, Palk C, McIntosh AS, Beatty KT. Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis. Gait Posture 2008;27(3):518–529 Abu-Faraj ZO, Harris GF, Smith PA. Surgical rehabilitation of the planovalgus foot in cerebral palsy. IEEE Trans Neural Syst Rehabil Eng 2001;9(2):202-214 PubMed Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clin Sports Med 1983;2(2):247–270