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 该应用的目的是通过集成，新颖的成像和可视化开发机器人工作站 在最小侵入性脊柱（MIS）手术中执行复杂任务的能力目前无法进行 使用传统的手术工具和方法进行。该应用程序的具体重点将是两个 复杂的手术：椎板切除术减压和透射腰椎室内融合（TLIF）手术。 我们建议开发图像引导的原型机器人系统，用于计划，实时术中 监视，导航和更新计划。 每年在全球范围内进行超过500万次脊柱手术，联合有130万次手术 一个人。在腰部（腰椎）中，通常进行减压和融合以治疗 导致脊柱狭窄的多种病理（神经压缩），包括：退化性椎间盘疾病， 赞助（脊柱关节炎），赞助（转化不稳定）和脊柱畸形，例如脊柱侧弯。 随着美国人口的持续年龄，脊柱融合手术变得越来越多 在过去的十年中很常见。 脊柱融合是一种手术技术，可在两个或多个椎骨之间产生骨（骨）联合 骨骼以消除任何细分段运动。在现代时代，这是通过放置椎骨来完成的 螺钉（在单个椎体中的锚固）与横跨多个椎骨的杆相连。 此外，经常在圆盘空间中放置机械装置以促进直接骨头 椎体之间的生长。执行此过程的一种流行的方法被称为 透射腰椎室内融合或“ TLIF”。 螺钉和车主设备的放置在技术上是具有挑战性的，因为它们与至关重要 神经和血管结构。当前的商业机器人系统仅着眼于指导椎弓根螺钉。 这些系统通常依赖于术前成像，该成像与术中定位数据合并 校准和轨迹计划。计划的螺丝轨迹由外科医生手动执行。 在脊柱手术（例如TLIF）的复杂任务中（去除椎间盘，骨头末端板 准备，并通过干扰拟合以促进融合而放置生物力学的叉状），外科医生是 解剖学的约束限制了它们的可视化和方法。为了实现他们的目标， 外科医生经常对正常解剖结构造成附带损害。 我们提出，与持续灵巧的操纵器（CDM）集成的主动手术机器人系统（CDM） 可以提供完成复杂的脊柱手术任务的能力，例如脊柱减压和TLIF 与传统的组织相比 开放手术和传统的脊柱手术。