Robotic-Navigated Percutaneous Pedicle Screw Placement Has Less Facet Joint Violation Than Fluoroscopy-Guided...

Area of Science:

• Spine Surgery
• Orthopedic Technology
• Surgical Navigation

Background:

• Percutaneous pedicle screw (PPS) placement is crucial for stabilizing thoracolumbar spine trauma.
• Fluoroscopy-guided techniques carry risks of pedicle screw malposition and facet joint violation (FJV).
• Robotic assistance offers potential for enhanced precision in spinal instrumentation.

Purpose of the Study:

• To directly compare robotic-assisted versus fluoroscopy-guided PPS placement in thoracolumbar spine trauma.
• To evaluate differences in clinically acceptable pedicle screw accuracy.
• To assess the frequency of facet joint violation (FJV) between the two techniques.

Main Methods:

• Retrospective chart review of 37 trauma patients undergoing percutaneous thoracic/lumbar fixation.
• Analysis of postoperative CT scans by blinded reviewers to assess screw accuracy and FJV.
• Comparison of 143 PPS placed with robotic assistance versus 149 PPS placed with fluoroscopy.

Main Results:

• Robotic assistance significantly decreased overall FJV frequency (2.8% vs. 14.8%, P=0.0003).
• The robot group showed significantly lower FJV in the thoracic spine (0% vs. 17.7%, P=0.0209) compared to controls.
• Clinically acceptable screw trajectory accuracy was comparable between robotic and fluoroscopy groups (84.6% vs. 81.9%, P=0.6388).

Conclusions:

• Robotic-assisted PPS placement did not significantly improve screw trajectory accuracy compared to fluoroscopy.
• Robotic technology significantly reduced facet joint violations, particularly in the thoracic spine.
• Robotic assistance may enhance radiographic outcomes and safety for specific spinal surgeries and patient populations.