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. 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