Evaluating accuracy in robotic-assisted thoracolumbar pedicle screw placement: Insights from a single-center study of 410 patients

Study Design: A single-center prospective study evaluating the accuracy and factors influencing robotic-assisted pedicle screw placement in the thoracolumbar spine. Objectives: To assess the accuracy of robotic-assisted pedicle screw placement in thoracolumbar spine surgeries and to analyze the factors that enhance or hinder the precision of robotic systems in a single-center setting. Summary of Background Data: Robotic systems are significant advancement in spinal surgery, offering added advantage in pedicle screw placement compared to conventional methods such as freehand, fluoroscopy-guided, and computer-aided navigation (CAN)-guided techniques. Robots combine CAN with a stable mechanical arm, ensuring accurate placement along preplanned trajectories, particularly advantageous in complex anatomies. Methods: A total of 410 patients who underwent robotic-assisted thoracolumbar spine surgery were included in the study. Pedicle screws were placed with robotic assistance using an optimized workflow. Screw placement accuracy was evaluated using the Gertzbein–Robbins classification, with screws graded A and B considered clinically acceptable. Results: Of the 2600 screws placed, 99.2% were clinically acceptable (93.4% Grade A and 5.8% Grade B), with only 0.8% exhibiting breaches requiring revision. Lateral breaches were the most common (59.1%). Robotic system usage averaged 20.6 min, with an average time of 3.8 min per screw insertion. Postoperative outcomes included a mean Visual Analog Scale pain score of 7.3 and an average hospital stay of 4.7 days. Conclusions: Robotic-assisted pedicle screw placement using the Mazor X system demonstrated high accuracy and minimal revision rates. Robotic integration reduces complications and streamlines workflows, improving patient safety and advancing spine surgery standards.