Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle...

Area of Science:

• Spine surgery
• Robotic surgery
• Orthopedic surgery

Background:

• Robotic adoption in spine surgery is increasing.
• Protocols for intraoperative 3D imaging after robotic pedicle screw placement are emerging.
• The utility and risks (radiation, operative time) of these advanced imaging protocols are not well-studied.

Purpose of the Study:

• To determine the utility of advanced imaging in confirming robotic pedicle screw placement.
• To evaluate whether routine intraoperative 3D imaging is necessary for robotic pedicle screw placement.

Main Methods:

• Retrospective cohort study of 70 patients undergoing lumbar spinal fusion with robotic and navigation systems.
• Intraoperative 3D imaging used to evaluate 354 robotically placed pedicle screws.
• Screw accuracy assessed using the Gertzbein and Robbins system (GRS), with A or B considered acceptable.

Main Results:

• All 354 robotically placed pedicle screws achieved acceptable accuracy (GRS A or B).
• 99.2% of screws were GRS A, and 0.08% were GRS B.
• No screw-related complications were reported. Average radiation dose from 3D imaging was 289.7±164.6 mGy.

Conclusions:

• Robotic systems achieve accurate pedicle screw placement without the need for intraoperative 3D imaging.
• Routine use of 3D imaging increases radiation exposure and operative time.
• Intraoperative 3D imaging should be reserved for cases with heightened clinical concern.