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Updated: Sep 30, 2026
A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
Fully percutaneous, navigation-assisted cervical pedicle screw instrumentation: technical note and a report of safety
Gonzalo Moros-Daza1, Feras Rawagah2,3, Bujung Hong2
1Department of Neurosurgery, Medical University Lausitz - Carl Thiem, Cottbus, Germany. g.moros@mul-ct.de.
Introduction:
Cervical pedicle screws provide superior biomechanical stability compared with lateral mass screws, resulting in stronger and more durable constructs. Furthermore, most published reports consist of small retrospective series or feasibility studies, and prospective evidence regarding fully percutaneous navigation-assisted cervical pedicle screw fixation remains scarce. We present a technical note on fully percutaneous cervical pedicle screw instrumentation and report the preliminary radiological and clinical outcomes of our initial case series.
Materials And Methods:
Data from thirteen consecutive patients and forty-two cervical pedicle screws were prospectively collected between October 2024 and September 2025. The primary outcomes were radiological screw placement accuracy assessed using the Bredow classification, the need for screw revision, and clinical safety. Safety was assessed by the occurrence of new postoperative neurological deficits attributable to screw malposition, cerebrospinal fluid (CSF) leak, postoperative infection, vertebral artery injury, and implant-related complications. Additional perioperative safety outcomes, including intraoperative blood loss, surgical time, and length of stay, were recorded. Postoperative pain was additionally assessed using the Visual Analog Scale (VAS).
Results:
Traumatic fracture was the most common underlying pathology. Thirty-six screws (85.7%) were classified as Bredow Grades 1-2, while six (14.3%) were Grades 3-5. One of 42 screws (2.4%) required revision. One patient experienced rod dislocation, and another developed occipital neuralgia. No new postoperative neurological deficits attributable to screw malposition, cerebrospinal fluid (CSF) leak, postoperative infection, or vertebral artery injury were observed. Median VAS decreased from 7 preoperatively to 2 at the 30-day follow-up (p = 0.003).
Conclusions:
Fully percutaneous, navigation-assisted cervical pedicle screw fixation appears to be a feasible technique. These preliminary findings should be interpreted with caution given the limited sample size and short follow-up. Larger comparative studies are required to further evaluate the safety, accuracy, and reproducibility of this technique.
