Mazor X Stealth Versus O-arm Navigation for Pedicle Screw Insertion

NCT ID: NCT04353895

Last Updated: 2022-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-01

Study Completion Date

2023-12-31

Brief Summary

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The investigators would like to investigate the fluoro-registered Mazor X Stealth in terms of pedicle screw accuracy and radiation exposure in comparison with the O-arm and navigation as the institutional gold standard.

Detailed Description

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Pedicle screw insertion for spinal fusion is a surgical procedure regularly performed around the world. Surgeons use free-hand, navigation or robotic techniques. The navigation began in 1995 in spine surgery. Surgical navigation systems provide pedicle screw insertion by projecting screw trajectories on a three-dimensional (3D) image acquisition, preoperatively or during the surgical procedure. Laine et al reported better accuracy and safety in pedicle screw insertion using the navigation system. Other authors reported less irradiation with the use of computer-assisted navigation. Robotic guidance was introduced in 2006 and assists the surgeon through a mechanical guidance according to a planning of screw trajectories on 3D imaging. This technique allows stable guidance for pedicle drilling and screw insertion, leading to greater screw positioning in lumbar fusion.

Medtronic (Medtronic, Minneapolis, MN, USA) introduced the Mazor X Stealth in Europa in 2019, including the Mazor robotic device with the navigation technology within the same system. The hypothesis would be a combination of the stability of the robot during screw insertion and the accuracy of the navigation with cumulative benefit from the two techniques.

The goal of this study is to compare radiological and clinical results of the use of the new Mazor Stealth with the surgical O-arm navigation during pedicle screw insertion for posterior lumbar fusion.

Conditions

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Disorder of Spine

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Medical device compared with gold standard
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Participants
single-blind, only for the patient, after randomization

Study Groups

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Robotic group (RG)

Patients in the RG group will be operated using the assistance of the Mazor X Stealth robot

Group Type EXPERIMENTAL

Guidance for pedicle screw insertion (Mazor Stealth)

Intervention Type DEVICE

Using imaging devices and navigation for guidance, we perform a posterior vertebral fusion with pedicle screw insertion

O-arm navigation group (NV)

Patients in the NV group will be operated using the guidance of the Stealth navigation

Group Type ACTIVE_COMPARATOR

Guidance for pedicle screw insertion (O-arm Navigation)

Intervention Type DEVICE

Using imaging devices and navigation for guidance, we perform a posterior vertebral fusion with pedicle screw insertion

Interventions

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Guidance for pedicle screw insertion (Mazor Stealth)

Using imaging devices and navigation for guidance, we perform a posterior vertebral fusion with pedicle screw insertion

Intervention Type DEVICE

Guidance for pedicle screw insertion (O-arm Navigation)

Using imaging devices and navigation for guidance, we perform a posterior vertebral fusion with pedicle screw insertion

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* adult patients
* who require pedicle screw insertion for vertebral posterior stabilization

Exclusion Criteria

* children
* participants incapable of judgment
* participants under tutelage
* vertebral fusion indication without pedicle screw implantation
* refusal to participate
* data missing for radiation exposure calculation
* unstable vertebral fracture requiring urgent fixation
* pregnancy
* refusal to participate
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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P. D. Dr. med. Duccio BOSCHERINI

OTHER

Sponsor Role lead

Responsible Party

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P. D. Dr. med. Duccio BOSCHERINI

Director of the Neuro Orthopedic Center

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Duccio Boscherini, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Neuro Orthopedic Center

Locations

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Neuro Orthopedic Center

Lausanne, Canton of Vaud, Switzerland

Site Status RECRUITING

Countries

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Switzerland

Central Contacts

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Duccio Boscherini, MD, PhD

Role: CONTACT

+41216470525

Marc Prod'homme, MD

Role: CONTACT

+41216470525

Facility Contacts

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Duccio Boscherini, MD, PhD

Role: primary

+41793679495

Marc Prod'homme, MD

Role: backup

+41764112523

References

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Staartjes VE, Molliqaj G, van Kampen PM, Eversdijk HAJ, Amelot A, Bettag C, Wolfs JFC, Urbanski S, Hedayat F, Schneekloth CG, Abu Saris M, Lefranc M, Peltier J, Boscherini D, Fiss I, Schatlo B, Rohde V, Ryang YM, Krieg SM, Meyer B, Kogl N, Girod PP, Thome C, Twisk JWR, Tessitore E, Schroder ML. The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion. BMJ Open. 2019 Sep 8;9(9):e030389. doi: 10.1136/bmjopen-2019-030389.

Reference Type BACKGROUND
PMID: 31501123 (View on PubMed)

Nolte LP, Zamorano L, Visarius H, Berlemann U, Langlotz F, Arm E, Schwarzenbach O. Clinical evaluation of a system for precision enhancement in spine surgery. Clin Biomech (Bristol). 1995 Sep;10(6):293-303. doi: 10.1016/0268-0033(95)00004-5.

Reference Type BACKGROUND
PMID: 11415570 (View on PubMed)

Staartjes VE, Klukowska AM, Schroder ML. Pedicle Screw Revision in Robot-Guided, Navigated, and Freehand Thoracolumbar Instrumentation: A Systematic Review and Meta-Analysis. World Neurosurg. 2018 Aug;116:433-443.e8. doi: 10.1016/j.wneu.2018.05.159. Epub 2018 May 31.

Reference Type BACKGROUND
PMID: 29859354 (View on PubMed)

Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000 Jun;9(3):235-40. doi: 10.1007/s005860000146.

Reference Type BACKGROUND
PMID: 10905443 (View on PubMed)

Hartl R, Lam KS, Wang J, Korge A, Kandziora F, Audige L. Worldwide survey on the use of navigation in spine surgery. World Neurosurg. 2013 Jan;79(1):162-72. doi: 10.1016/j.wneu.2012.03.011. Epub 2012 Mar 30.

Reference Type BACKGROUND
PMID: 22469525 (View on PubMed)

Lieberman IH, Togawa D, Kayanja MM, Reinhardt MK, Friedlander A, Knoller N, Benzel EC. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: Part I--Technical development and a test case result. Neurosurgery. 2006 Sep;59(3):641-50; discussion 641-50. doi: 10.1227/01.NEU.0000229055.00829.5B.

Reference Type BACKGROUND
PMID: 16955046 (View on PubMed)

Togawa D, Kayanja MM, Reinhardt MK, Shoham M, Balter A, Friedlander A, Knoller N, Benzel EC, Lieberman IH. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: part 2--Evaluation of system accuracy. Neurosurgery. 2007 Feb;60(2 Suppl 1):ONS129-39; discussion ONS139. doi: 10.1227/01.NEU.0000249257.16912.AA.

Reference Type BACKGROUND
PMID: 17297375 (View on PubMed)

Schroder ML, Staartjes VE. Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis. Neurosurg Focus. 2017 May;42(5):E12. doi: 10.3171/2017.3.FOCUS16534.

Reference Type BACKGROUND
PMID: 28463610 (View on PubMed)

Heary RF, Bono CM, Black M. Thoracic pedicle screws: postoperative computerized tomography scanning assessment. J Neurosurg. 2004 Apr;100(4 Suppl Spine):325-31. doi: 10.3171/spi.2004.100.4.0325.

Reference Type BACKGROUND
PMID: 15070139 (View on PubMed)

Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990 Jan;15(1):11-4. doi: 10.1097/00007632-199001000-00004.

Reference Type BACKGROUND
PMID: 2326693 (View on PubMed)

The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. doi: 10.1016/j.icrp.2007.10.003.

Reference Type BACKGROUND
PMID: 18082557 (View on PubMed)

Servomaa A, Tapiovaara M. Organ dose calculation in medical x ray examinations by the program PCXMC. Radiation protection dosimetry. 1998 Nov 1;80(1-3):213-9

Reference Type BACKGROUND

Nuclear Energy Agency Forum on Stakeholder ConfidenceChilton Seminar: Roger Cox -'Risks from low doses of low-LET radiation - the US National Academy of Sciences BEIR VII report'SRP Meeting on Source ManagementScientific Symposium to Mark the Past and Future Achievements of Richard Doll. Journal of Radiological Protection. 2006;26(1):119-123

Reference Type BACKGROUND

Related Links

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Other Identifiers

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2020-00305

Identifier Type: -

Identifier Source: org_study_id

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