Evaluating accuracy in robotic-assisted thoracolumbar pedicle screw placement: Insights from a single-center study of 410 patients.

Study Design: A single-center prospective study evaluating the accuracy and factors influencing robotic-assisted pedicle screw placement in the thoracolumbar spine. Objectives: To assess the accuracy of robotic-assisted pedicle screw placement in thoracolumbar spine surgeries and to analyze the factors that enhance or hinder the precision of robotic systems in a single-center setting. Summary of Background Data: Robotic systems are significant advancement in spinal surgery, offering added advantage in pedicle screw placement compared to conventional methods such as freehand, fluoroscopy-guided, and computer-aided navigation (CAN)-guided techniques. Robots combine CAN with a stable mechanical arm, ensuring accurate placement along preplanned trajectories, particularly advantageous in complex anatomies. Methods: A total of 410 patients who underwent robotic-assisted thoracolumbar spine surgery were included in the study. Pedicle screws were placed with robotic assistance using an optimized workflow. Screw placement accuracy was evaluated using the Gertzbein-Robbins classification, with screws graded A and B considered clinically acceptable. Results: Of the 2600 screws placed, 99.2% were clinically acceptable (93.4% Grade A and 5.8% Grade B), with only 0.8% exhibiting breaches requiring revision. Lateral breaches were the most common (59.1%). Robotic system usage averaged 20.6 min, with an average time of 3.8 min per screw insertion. Postoperative outcomes included a mean Visual Analog Scale pain score of 7.3 and an average hospital stay of 4.7 days. Conclusions: Robotic-assisted pedicle screw placement using the Mazor X system demonstrated high accuracy and minimal revision rates. Robotic integration reduces complications and streamlines workflows, improving patient safety and advancing spine surgery standards.