A Retrospective Cohort Study Comparing Robot-Assisted and Conventional Fluoroscopy-Guided Pedicle Screw Placement

Background/Objectives: Pedicle screw placement is crucial for restoring stability. Emerging robot-assisted technologies may offer enhanced precision and reduced radiation exposure. This study aimed to compare the accuracy and clinical outcomes of robot-assisted versus conventional fluoroscopy-guided pedicle screw placements. Methods: This retrospective cohort study included 218 patients undergoing pedicle screw placement at a single spine center between 2019 and 2023. Of these, 105 patients underwent robot-assisted surgery using the Mazor X™ Stealth Edition (Medtronic, Minneapolis, MN, USA), and 113 underwent conventional fluoroscopy-guided surgery. The primary outcome was screw placement accuracy (Grade 0 = optimal, Grades 1–3 = suboptimal, according to the Gertzbein–Robbins classification). Secondary outcomes included estimated blood loss (EBL), radiation exposure, length of hospital stay (LOS), clinical outcome according to the Macnab classification, postoperative pain, and adverse events. Results: Robot-assisted surgery demonstrated significantly higher accuracy in screw placement, with 93.33% achieving Grade 0 accuracy versus 78.76% in the conventional group (p = 0.002). This corresponded to an odds ratio (OR) of 3.78 (95% CI: 1.55–9.19, p = 0.003). The number needed to treat (NNT) to achieve one additional optimal screw placement was 6.9. Robot-assisted surgery demonstrated significantly higher accuracy in screw placement. Moreover, robot-assisted procedures were associated with reduced estimated blood loss (EBL), shorter length of stay (LOS), and lower radiation exposure times; patient-reported outcomes (VAS and Macnab) were also improved (OR = 3.34, 95% CI: 1.89–5.91). Duration of surgery, adverse events, and revision rates were comparable between the two groups. Conclusions: This study supports the clinical benefits of robot-assisted pedicle screw placement, particularly in achieving higher accuracy and reducing EBL and LOS. Future research should explore long-term outcomes, cost-effectiveness, and the generalizability of these results to a broader patient population.