Robot-assisted percutaneous vertebroplasty under local anesthesia: A robotic segment-specific analysis of puncture accuracy and clinical outcomes.

The integration of robotic guidance into spinal procedures is designed to enhance precision and overcome anatomical challenges. Robot-assisted percutaneous vertebroplasty (PVP) represents a significant advancement in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, its performance under local anesthesia can be influenced by factors such as respiratory motion, patient cooperation, and anatomical variations across spinal segments, potentially leading to differences in puncture accuracy and operational efficiency. This study aimed to evaluate the segment-specific differences in puncture accuracy, operational efficiency, and clinical outcomes of robot-assisted PVP performed under local anesthesia. A retrospective analysis was conducted on 312 patients with 312 fractured vertebrae who underwent robot-assisted PVP under local anesthesia between June 2023 and December 2024. Given the low incidence of OVCFs in the upper thoracic spine, patients were stratified into four groups based on the treated vertebral level: T1-8 (n = 26), T9-12 (n = 98), L1-3 (n = 142), and L4-5 (n = 46). Outcomes included puncture accuracy (assessed using the Gertzbein and Robbins scale), operational times (registration/planning, working channel establishment, total surgical duration), visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and complication rates. The L1-3 group exhibited the shortest working channel establishment time (3.5 ± 0.8 min) and the highest puncture accuracy (96.5% grades A + B). The T1-8 group required the longest registration/planning time (8.5 ± 2.0 min) and demonstrated the lowest puncture accuracy (69.2% grades A + B), which was attributable to respiratory artifacts and complex anatomy. All groups showed significant and comparable improvements in VAS and ODI scores postoperatively (P < 0.001), with no significant differences in complication rates (P > 0.05). Robot-assisted PVP under local anesthesia is an effective and safe treatment for OVCFs across all segments. However, significant segment-specific variations exist in puncture accuracy and operational efficiency. The upper thoracic spine (T1-8) presents the greatest technical challenges, necessitating meticulous preoperative planning and potential technological adaptations to mitigate the impact of respiratory motion and the complex anatomy.