Background: Most studies conducted by early adopters of the third generation robotic-assisted pedicle screw placement systems have predominantly focused on the placement of thoracolumbar pedicle screws. The current study is a report on 750 cases of robotic assisted spine surgery, for varied etiologies from the occiput to the sacrum in all manner of spine surgeries. Materials and Methods: In a prospective study, the 750 consecutive patients who underwent robotic-assisted screw insertion using MazorX Stealth Edition (Medtronic Ltd, Dublin, Ireland) were included. Thus, 4921 implants placed from occiput to ilium. The demographic and surgical details of all patients was noted and postoperative O-arm scans were done to determine accuracy of implants. Results: In the current series, total of 4921 posterior spinal anchors were implanted, including 443 cervical pedicle screws, 15 cervical lateral mass screws, 4457 thoracolumbar pedicle screws (with 58 S2AI screws), and 6 ilio-sacral screws. 74 vertebrae received bone cement augmentation. 10 robotically inserted screws were revised due to unacceptable pedicle breaches. The overall clinical acceptability of screws was 99.8%. Analysis of preoperative plans and postoperative O-arm scans revealed no statistically significant differences between planned and executed screw trajectories. Conclusion: The third generation robotic-assisted pedicle screw placement system along with intraoperative 3-D O-arm imaging is useful in safe and accurate placement of posterior spinal anchors in cervical and thoracolumbar spine.
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