Robotic-guidance for pedicle screws can reportedly increase placement accuracies and surgical efficiencies especially in percutaneous approaches.
The study aimed to compare the accuracy of percutaneous pedicle screw placement and post-operative course of robotic-guidance versus fluoroscopy-guidance performed by a surgeon experienced in performing fluoroscopy-guided MIS spinal fusions.
This is a retrospective medical chart review of 2 cohorts of consecutive patients operated by the same surgeon.
Medical records of adults suffering from degenerative spine disease treated by percutaneous spinal fusion surgeries with robotic-guidance vs. fluoroscopy-guidance were reviewed. Endpoints included pedicle screw placement accuracy (on post-operative CTs) and surgical complications and revisions.
Ninety-nine patients were reviewed in each arm which were similar in demographics and surgical indications. The robotic arm had 5.8 screws per case on average and 6.0 in the control arm (p=0.65). No significant differences were found in postoperative complication rates revision surgeries length of stay duration of surgery screw implantation times blood loss or results of Oswestry Disability Index questionnaires.
Post-operative CTs were available for 52 patients (293 screws) in the robotic arm and 70 (421 screws) in the freehand controls. In the robotic arm 100% of screws were found accurately placed within the “safe zone” vs. 410 screws (97.4%) in the control arm (p=0.005). Of 11 breaching screws in the control arm one breached by 6mm but the patient did not suffer from any sequelae (12-month follow-up). The average follow up period was 9.2±4 months in the robotic-guided arm and 10.5±3 in the control arm. There were no significant differences in complications or revisions.
A modest yet statistically significant increase in pedicle screw placement accuracy was observed with robotic-guidance compared to freehand. Larger prospective studies are needed to demonstrate differences in clinical outcomes.
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* Address correspondence to this author at the Faissal Zahrawi, MD, 400 Celebration Pl. a280, Celebration, FL 34747, USA; firstname.lastname@example.org.