Robotic System for Spinal Decompression and Interbody Fusion

脊柱减压和椎间融合机器人系统

• 批准号: 10355589
• 负责人: MEHRAN ARMAND
• 金额: $ 58.38万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-18 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10355589
• 关键词: Address; Affect; Age; Aging; Anatomy; Animals; Aorta; Arthritis; Back; Biomechanics; Blood Vessels; Bone Growth; Cadaver; Calibration; Complex; Complication; Data; Debridement; Deformity; Development; Devices; Excision; Facet joint structure; Functional disorder; Goals; Growth; Hybrids; Image; Imagery; Implant; Individual; Injury; Intervertebral disc structure; Intraoperative Monitoring; Laminectomy; Lead; Lower Extremity; Magnetic Resonance Imaging; Manuals; Modeling; Modernization; Modification; Motion; Motor; Nerve; Nerve Tissue; Nerve compression syndrome; Neurologic Deficit; Neurosurgeon; Operative Surgical Procedures; Orthopedics; Pain in lower limb; Pathology; Patients; Performance; Persons; Plant Roots; Population; Positioning Attribute; Procedures; Process; Reporting; Resected; Robot; Robotics; Rod; Roentgen Rays; Sensory; Series; Shapes; Site; Spinal; Spinal Cord; Spinal Fusion; Spinal Stenosis; Spinal nerve structure; Spine surgery; Spondylarthritis; Spondylolisthesis; Spondylosis; Stenosis; Structure; Surgeon; Surgical Error; System; Techniques; Technology; Time; Tissues; Training; Tube; United States; Update; Variant; Vertebral Bone; Vertebral column; Visualization; base; chronic back pain; data fusion; design; dexterity; flexibility; image guided; image visualization; instrument; intervertebral disk degeneration; mechanical device; minimally invasive; novel; novel therapeutic intervention; operation; pain sensation; pressure; procedure safety; prototype; reconstruction; reduce symptoms; relating to nervous system; robotic system; scoliosis; sensory input; soft tissue; tool; vertebra body

Summary The goal of this application is to develop a robotic workstation with integrated, novel imaging and visualization capabilities to perform complex tasks in minimally-invasive spine (MIS) surgery that cannot be currently performed with conventional surgical tools and approaches. The specific focus of this application will be two complex surgeries: laminectomy decompression and Transforaminal Lumbar Interbody Fusion (TLIF) Surgery. We propose the development of an image-guided prototype robotic system for planning, real-time intraoperative monitoring, navigation, and updating of the plans. There are over 5 million spinal operations performed worldwide annually, with 1.3 million surgeries in the United States alone. In the low back (lumbar spine), decompression and fusion are commonly performed to treat a variety of pathologies that result in spinal stenosis (compression of nerves), including: degenerative disc disease, spondylosis (spinal arthritis), spondylolisthesis (translational instability) and spinal deformities such as scoliosis. As the population of the United States continues to age, spinal fusion surgery has become increasingly more common over the last decade. Spinal fusion is a surgical technique that creates an osseous (bony) union between two or more vertebral bones to eliminate any intersegmental motion. In the modern era, this is accomplished by placement of pedicle screws (anchors in individual vertebral bodies) connected with rods that span across multiple vertebral bones. Additionally, placement of a mechanical device in the disc space is frequently performed to facilitate direct bone growth between the vertebral bodies. A popular approach to performing this procedure is known as a transforaminal lumbar interbody fusion or “TLIF.” Placement of screws and interbody devices are technically challenging due to their close proximity to vital neural and vascular structures. The current commercial robotic systems focus on guiding pedicle screws only. These systems generally rely on preoperative imaging that is merged with intraoperative positioning data for calibration and trajectory planning. The planned screw trajectory is executed by the surgeon manually. In complex tasks in spinal surgery such as TLIF (where the intervertebral disc is removed, bony end plates are prepared, and biomechanical implants are placed through interference fit to facilitate fusion), surgeons are limited in their visualization and approach by the constraints of the anatomy. In order to accomplish their goals, surgeons frequently create collateral damage on normal anatomical structures. We propose that an active surgical robotic system integrated with continuum dexterous manipulators (CDM) may provide the ability to accomplish complex spinal surgical tasks such as spinal decompression and TLIF with less disruption to surrounding tissues, and thus, result in reduction of collateral damage compared to traditional, open surgery and traditional MIS spinal surgery.

概括 该应用程序的目标是开发一个具有集成、新颖的成像和可视化功能的机器人工作站 在微创脊柱 (MIS) 手术中执行目前无法执行的复杂任务的能力 使用传统手术工具和方法进行的该应用的具体重点有两个。 复杂的手术：椎板切除减压和经椎间孔腰椎椎间融合（TLIF）手术。 我们建议开发一种图像引导原型机器人系统，用于规划、实时术中 监控、导航和更新计划。 全球每年进行超过 500 万例脊柱手术，其中 130 万例手术在美国进行 仅在腰部（腰椎），通常进行减压和融合来治疗。 导致椎管狭窄（神经受压）的多种病理，包括：退行性椎间盘疾病， 脊椎病（脊柱关节炎）、脊椎滑脱（平移不稳定）和脊柱畸形，如脊柱侧凸。 随着美国人口持续老龄化，脊柱融合手术变得越来越多 近十年来很常见。 脊柱融合是一种手术技术，可在两个或多个椎骨之间形成骨性（骨性）连接 在现代，这是通过放置椎弓根来实现的。 螺钉（固定在单个椎体中）与跨越多个椎骨的杆连接。 此外，经常在椎间盘间隙中放置机械装置，以方便直接接骨 执行此过程的流行方法称为椎体之间的生长。 经椎间孔腰椎椎间融合术或“TLIF”。 螺钉和椎体间装置的放置在技术上具有挑战性，因为它们靠近生命体 当前的商业机器人系统仅专注于引导椎弓根螺钉。 这些系统通常依赖于与术中定位数据合并的术前成像 校准和轨迹规划。规划的螺钉轨迹由外科医生手动执行。 在脊柱手术中的复杂任务中，例如 TLIF（移除椎间盘、骨终板） 准备好，并通过过盈配合放置生物力学植入物以促进融合），外科医生 为了实现他们的目标，他们的可视化和方法受到解剖学的限制。 外科医生经常对正常解剖结构造成附带损伤。 我们提出一种与连续灵巧机械手（CDM）集成的主动手术机器人系统 可以提供完成复杂脊柱外科任务的能力，例如脊柱减压和 TLIF 与传统的、 开放手术和传统的 MIS 脊柱手术。