Loggia Giuseppe, Avrumova Fedan, Lebl Darren R
Department of Spine Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10021, USA.
J Clin Med. 2025 May 29;14(11):3804. doi: 10.3390/jcm14113804.
: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation is limited. During RA spine surgery, navigation systems display three-dimensional data, but factors such as registration errors, intraoperative motion, and anatomical variability may compromise accuracy. This technical note describes a visuohaptic intraoperative phenomenon observed during RA spine surgery, its underlying mechanical principles, and its utility. During pedicle screw insertion with a slow-speed automated drill in RA spine procedures, a subtle and rhythmic variation in resistance has been observed both visually on the navigation interface and haptically through the handheld drill. This intraoperative pattern is referred to in this report as a cyclical insertional torque (CIT) pattern and has been noted across multiple cases. The CIT pattern is hypothesized to result from localized stick-slip dynamics, where alternating phases of resistance and release at the bone-screw interface generate periodic torque fluctuations. The pattern is most pronounced at low insertion speeds and diminishes with increasing drill velocity. CIT is a newly described intraoperative observation that may provide visuohaptic feedback during pedicle screw insertion in RA spine surgery. Through slow-speed automated drilling, CIT offers a cue for bone engagement, which could support intraoperative awareness in scenarios where tactile feedback is reduced or visual confirmation is indirect. While CIT may enhance surgeon confidence during screw advancement, its clinical relevance, reproducibility, and impact on placement accuracy have yet to be validated.
机器人辅助（RA）脊柱手术通过实时导航和轨迹引导提高了椎弓根螺钉置入的准确性。然而，徒手操作缺乏传统的直接触觉反馈，这仍然是一些人所担忧的问题，特别是在微创（MIS）手术中，直接视觉确认有限。在RA脊柱手术中，导航系统显示三维数据，但诸如配准误差、术中运动和解剖变异等因素可能会影响准确性。本技术说明描述了在RA脊柱手术中观察到的一种视觉触觉术中现象、其潜在的力学原理及其用途。在RA脊柱手术中使用低速自动钻进行椎弓根螺钉置入时，在导航界面上可直观观察到，通过手持钻也能触觉感受到阻力存在细微且有节奏的变化。本报告中将这种术中模式称为周期性插入扭矩（CIT）模式，并且在多个病例中都有发现。据推测，CIT模式是由局部粘滑动力学引起的，在骨-螺钉界面处阻力和释放的交替阶段会产生周期性扭矩波动。这种模式在低插入速度时最为明显，并随着钻速的增加而减弱。CIT是一种新描述的术中观察结果，可能在RA脊柱手术中椎弓根螺钉置入过程中提供视觉触觉反馈。通过低速自动钻孔，CIT为骨接触提供了一个提示，这可以在触觉反馈减少或视觉确认不直接的情况下支持术中感知。虽然CIT可能会增强外科医生在螺钉推进过程中的信心，但其临床相关性、可重复性以及对置入准确性的影响尚未得到验证。
