Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution.

Abstract

In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation. A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. Radiographic evaluation of preoperative and postoperative computerized tomography (CT) scans were collected. In the first 106 cases, 630 lumbosacral pedicle screws were placed. Thirty screws were placed in five patients without the robot because of surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance, only 1.5% (9/600) were repositioned intraoperatively. This study demonstrated a high level of accuracy (98.2%) in terms of grade A or B pedicle screw breach scores in the clinical use of navigated, robot-assisted surgery in its first 101 cases.