Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement

TLDR

Robotic‑guided and percutaneous pedicle screw placement are emerging technologies. The study retrospectively compared conventional open, open robotic‑guided, and percutaneous robotic‑guided pedicle screw placement. A cohort of 112 patients (35 percutaneous, 20 open robotic‑guided, 57 open conventional) was analyzed using CT scans to assess intra‑ and peri‑operative parameters. Robot‑assisted screws were 94.5 % accurate versus 91.4 % for conventional screws, robotic guidance cut X‑ray exposure from 77 s to 34 s per screw, and percutaneous procedures were linked to lower opioid use, shorter hospital stays, and fewer adverse events, suggesting better peri‑operative outcomes.

Abstract

Robotic-guided and percutaneous pedicle screw placement are emerging technologies. We here report a retrospective cohort analysis comparing conventional open to open robotic-guided and percutaneous robotic-guided pedicle screw placement. 112 patient records and CT scans were analyzed concerning the intraoperative and perioperative course. 35 patients underwent percutaneous, 20 open robotic-guided and 57 open conventional pedicle screw placement. 94.5% of robot-assisted and 91.4% of conventionally placed screws were found to be accurate. Percutaneous robotic and open robotic-guided subgroups did not differ obviously. Average X-ray exposure per screw was 34 s in robotic-guided compared to 77 s in conventional cases. Subgroup analysis indicates that percutaneously operated patients required less opioids, had a shorter hospitalization and lower rate of adverse events in the perioperative period. The use of robotic guidance significantly increased accuracy of screw positioning while reducing the X-ray exposure. Patients seem to have a better perioperative course following percutaneous procedures.