Value Proposition
· High Accuracy and Precision: Delivers superior injection accuracy and precision compared to freehand technique by an experienced provider, improving clinical outcomes
· Improved Safety: Reduces risk of catastrophic spinal cord injuries caused by misplaced injections
· Autonomous Injections: Performs spinal injections fully autonomously without manual needle insertion, enabling tele-surgery applications
· Fiducial-Free Navigation: Uses only preoperative and intraoperative images for navigation, simplifying setup compared to external marker-based systems
· Widely Applicable: Supports epidural steroid injections, transforaminal, interlaminar, and caudal injections, selective nerve root blocks, medial branch blocks, and radio frequency ablations
Unmet Need
· In the United States, epidural steroid injections are the most frequently performed procedure in pain medicine, with more than 10 million administered annually.
· Current epidural steroid injections are administered by physician experts via ultrasound, fluoroscopically, or CT-guidance with external fiducial markers. Their effectiveness depends on accuracy of placement and can vary based on the provider’s experience and technique. Poorly placed injections are usually futile; however, in some instances, poorly placed injections can result in catastrophic spinal cord injuries.
· Thus, there exists a strong need for developing an epidural steroid injection method that can meet high procedure while improving patient safety and outcomes.
Technology Description
· Researchers at Johns Hopkins have developed an autonomous image-guided robotic system for spinal cord injections with improved injection accuracy and precision.
· This system utilizes preoperative (CT or MRI) and intraoperative (C-arm or O-arm) imaging with a robotic arm to autonomously administer injections using a fiducial-free 2D/3D registration plan, guided in real time by novel software.
· Data demonstrate that robotic injection significantly improved pre- and post-operative needle tip accuracy from 20.1 to 11.4, improved needle tip precision from 15.6 mm to 10.1 mm, and halved needle angular orientation deviation from 12.0 degrees to 5.6 degrees compared to freehand injection.
Stage of Development
· Proof of concept has been demonstrated in a phantom study; however, the technology is yet to be tested in humans.
Data Availability
· Data can be found at the following link: Autonomous Spinal Robotic System for Transforaminal Lumbar Epidural Injections: A Proof of Concept of Study
Publication
Margalit A, Phalen H, Gao C, et al. Autonomous Spinal Robotic System for Transforaminal Lumbar Epidural Injections: A Proof of Concept of Study. Global Spine Journal. 2022;14(1):138-145. doi:
