ArticleJournal of robotic surgery2026
Comparative evaluation of CT-to-Fluoroscopy and Scan-and-Plan registration techniques in robot-assisted pedicle screw placement: a preliminary cadaveric faesibility 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
STUDY
designPreliminary Cadaveric Faesibility study. PURPOSE: To evaluate the preliminary faesibility, technical accuracy, and procedural metrics of CT-to-Fluoroscopy and Scan-and-Plan registration techniques in robot-assisted pedicle screw placement using the Mazor X robotic system.
backgroundRobot-assisted pedicle screw placement has been associated with improved accuracy and safety compared with conventional freehand techniques. However, direct comparisons between the two commonly used robotic registration workflows-CT-to-Fluoroscopy and Scan-and-Plan-remain limited. Evaluating their relative performance is important for optimizing surgical workflow and radiation utilization. METHODOLOGY: Four fresh-frozen male cadavers were allocated to CT-to-Fluoroscopy (n = 2) or Scan-and-Plan (n = 2) registration groups. Eight experienced spine surgeons inserted a total of 32 pedicle screws bilaterally from L2 to L5. Screw accuracy was assessed using the Gertzbein-Robbins classification and trajectory deviation analysis in axial, sagittal, and coronal planes. Procedural time, surgeon-reported ease of use, and radiation exposure were also evaluated.
resultsAll 32 screws were clinically acceptable (Grade A + B), resulting in 100% overall accuracy in both groups. CT-to-Fluoroscopy demonstrated a higher proportion of Grade A screws than Scan-and-Plan (87.5% vs. 50.0%; p = 0.054). Scan-and-Plan showed significantly lower sagittal angular deviation (0.55 ± 0.71° vs. 1.66 ± 1.14°; p = 0.002), superior clearance (0.20 ± 0.16 mm vs. 0.45 ± 0.36 mm; p = 0.038), and lower coronal angular deviation (0.59 ± 0.76° vs. 1.99 ± 1.74°; p = 0.002). Planning, execution, and overall procedure times were comparable between groups, although Scan-and-Plan required shorter registration time. Surgeon satisfaction was identical (4.75 ± 0.46). Radiation exposure to surgeons was negligible in both groups, while cadaver radiation exposure was higher with CT-to-Fluoroscopy.
conclusionBoth registration workflows achieved excellent accuracy. Scan-and-Plan demonstrated advantages in registration efficiency and patient-equivalent radiation exposure while maintaining comparable procedural performance, supporting its use when workflow optimization and radiation reduction are priorities.
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