Vital for spinal fracture treatment, pedicle screw fixation is the gold standard for spinal fixation procedures. Nevertheless, due to the screw pullout and loosening issues, this surgery often fails to be effective for patients suffering from osteoporosis (i.e., having low bone mineral density). These failures can be attributed to the rigidity of existing drilling instruments and pedicle screws forcing clinicians to place these implants into the osteoporotic regions of the vertebral body. To address this critical issue, we have developed a steerable drilling robotic system and evaluated its performance in drilling various J- and U-shape trajectories. Complementary to this robotic system, in this paper, we propose design, additive manufacturing, and biomechanical evaluation of a transformative flexible pedicle screw (FPS) that can be placed in pre-drilled straight and curved trajectories. To evaluate the performance of the proposed flexible implant, we designed and fabricated two different types of FPSs using the direct metal laser sintering (DMLS) process. Utilizing our unique experimental setup and ASTM standards, we then performed various pullout experiments on these FPSs to evaluate and analyze their biomechanical performance implanted in straight trajectories.
In this paper, with the goal of enhancing the minimally invasive spinal fixation procedure in osteoporotic patients, we propose a first-of-its-kind image-guided robotic framework for performing an autonomous and patient-specific procedure using a unique concentric tube steerable drilling robot (CT-SDR). Particularly, leveraging a CT-SDR, we introduce the concept of J-shape drilling based on a pre-operative trajectory planned in CT scan of a patient followed by appropriate calibration, registration, and navigation steps to safely execute this trajectory in real-time using our unique robotic setup. To thoroughly evaluate the performance of our framework, we performed several experiments on two different vertebral phantoms designed based on CT scan of real patients.
Spinal fixation procedures are currently limited by the rigidity of the existing instruments and pedicle screws leading to fixation failures and rigid pedicle screw pull out. Leveraging our recently developed Concentric Tube Steerable Drilling Robot (CT-SDR) in integration with a robotic manipulator, to address the aforementioned issue, here we introduce the transformative concept of Spatial Spinal Fixation (SSF) using a unique Flexible Pedicle Screw (FPS). The proposed SSF procedure enables planar and out-of-plane placement of the FPS throughout the full volume of the vertebral body. In other words, not only does our fixation system provide the option of drilling in-plane and out-of-plane trajectories, it also enables implanting the FPS inside linear (represented by an I-shape) and/or non-linear (represented by J-shape) trajectories. To thoroughly evaluate the functionality of our proposed robotic system and the SSF procedure, we have performed various experiments by drilling different I-J and J-J drilling trajectory pairs into our custom-designed L3 vertebral phantoms and analyzed the accuracy of the procedure using various metrics.
In this paper, we propose sequence-based pretraining methods to enhance procedural understanding in natural language processing. Procedural text, containing sequential instructions to accomplish a task, is difficult to understand due to the changing attributes of entities in the context. We focus on recipes, which are commonly represented as ordered instructions, and use this order as a supervision signal. Our work is one of the first to compare several 'order as-supervision' transformer pre-training methods, including Permutation Classification, Embedding Regression, and Skip-Clip, and shows that these methods give improved results compared to the baselines and SoTA LLMs on two downstream Entity-Tracking datasets: NPN-Cooking dataset in recipe domain and ProPara dataset in open domain. Our proposed methods address the non-trivial Entity Tracking Task that requires prediction of entity states across procedure steps, which requires understanding the order of steps. These methods show an improvement over the best baseline by 1.6% and 7-9% on NPN-Cooking and ProPara Datasets respectively across metrics.