Background: Pedicle screw fixation is an important technique in spine surgery. Violation of the pedicle can lead to neurovascular injury. Due to excellent pose repeatability, robotic technology may improve accuracy. Existing surgical spine robots use surgical assist architecture. This work explores the performance of a supervisory-control architecture robot (8i Robotics) for autonomous pedicle instrumentation. Methods: 3 porcine subjects underwent pedicle instrumentation utilizing the 7dof robot and were observed for 24 hours. Post-operative CT assessed screw location. Screws were graded clinically with the Gertzbein-Robbins Scale (GRS). Precision was assessed by a customized image processing pipeline. Euclidean error was calculated at screw head and screw tip. All points were normalized to a nominal screw, and confidence ellipses generated. Results: All animals were neurologically intact at 24 hours. All screws where GRS A. Mean tip and head Euclidean error where 2.47+/−1.25mm and 2.25+/-1.25mm respectively. Major and minor axes of the confidence ellipse at 99% was 2.19mm, and 1.28mm, and 2.07mm, and 0.42mm for tip and head respectively. Conclusions: 100% of screws obtained satisfactory clinical grading, with intact function in all animals post-operatively. This shows the capability of a supervisory-controlled 7DOF robot with OCT registration. Further investigation is warranted to further explore robotic capabilities, safety, and cost effectiveness.

Background: Tethered cord syndrome, a condition in which the spinal cord stretches as a child grows, can cause various clinical symptoms. Occult TCS (OTCS) is a condition where a child displays some or many clinical symptoms of TCS, but no radiographic abnormality confirms the presence of a tethered cord (1-4). Diagnosis of OTCS in children is invasive and multi-factorial. The current diagnostic approach involves three main factors- clinical signs and symptoms, radiographic evidence, and motor evoked potentials (MEPs) tested under general anesthesia. Transcranial magnetic stimulation (TMS) is a non-invasive testing method for OTCS. It can replace MEPs, which are conducted under general anesthesia. Methods: We will conduct a case-control series of children at our center who have undergone TMS. We will characterize the children who have TCS and suspected OTCS and detail the children’s current diagnosis methods and outcomes in a technical note. We will then compare their pre-operative and post-operative data. Results: So far, we have conducted TMS on 10 children to help diagnose occult TCS. Conclusions: This approach is a novel and effective way to improve the accuracy of diagnosis in children, potentially preventing unnecessary surgery, or detecting patients who would otherwise suffer from the condition.