ArticleJournal of robotic surgery2026
Level-specific accuracy of robotic-assisted versus fluoroscopy-assisted lumbar pedicle screw placement: a retrospective comparative cohort study.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background robotic-assisted (RA) pedicle screw placement has been increasingly adopted in lumbar spine surgery because of its potential to improve accuracy compared with conventional fluoroscopy-assisted (FA) techniques. However, vertebral level-specific differences remain insufficiently characterized. This study compared RA and FA lumbar pedicle screw placement focusing on level-specific and side-specific radiographic accuracy. Methods a retrospective single-center comparative cohort study was conducted using prospectively collected data. A total of 2065 lumbar pedicle screws were analyzed, including 1053 placed using RA and 1012 using conventional FA instrumentation. Screw accuracy was assessed postoperatively using the Gertzbein-Robbins classification, with Grade A considered optimal. Level-specific and side-specific analyses were performed for L1-L5. Fisher's exact test, clustered logistic regression, and propensity score weighted sensitivity analyses were used for statistical comparisons. Results Grade A placement was achieved in 99.1% of RA screws (1044/1053) versus 87.9% of FA screws (890/1012) (p < 0.001). Robotic-assisted instrumentation demonstrated significantly higher rates of optimal screw placement across all lumbar levels and both sides. The greatest relative differences were observed at upper lumbar levels, particularly L1-L2. At L5, Grade A placement reached 100.0% on the right side and 99.5% on the left side in the RA cohort, compared with 89.2% and 88.1% in the FA cohort (both p < 0.001). Fluoroscopy-assisted instrumentation independently predicted lower odds of optimal screw placement (OR 0.042, 95% CI 0.016-0.111; p < 0.001). Conclusions robotic-assisted lumbar pedicle screw placement was associated with significantly higher radiographic Grade A screw placement accuracy than FA instrumentation.
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