Implementing Robot-assisted Pedicle Screw Placement in a High Volume Spine Center

Introduction: Dorsal instrumentation of the spine using pedicle screws and rods is a standard procedure in spine surgery. Technical advances such as threedimensional imaging, neuronavigation and robot-assisted systems showed superior results when compared to conventional fluoroscopic screw placement. This study evaluates a new system for robot-assisted navigated pedicle screw placement.

Methods: Patients with indications for pedicle screw placement were prospectively included, as well as an evaluation of the surgeon. Screw placement was performed using neuronavigation and intraoperative threedimensional imaging. The trajectories for pedicle screw placement were adjusted using a robot-assisted system.

Results: 15 patients aged 72.3 +/- 16.6 years were prospectively included between June and December 2021. Overall, 108 pedicle screws were implanted. 75 (69.4%) screws were implanted using robotic assistance, 31 screws were placed using standard CT-guided neuronavigation. In six patients (40.0%) screw placement was performed completely robot-assisted. In nine patients limitations occurred due to adaptive difficulties and alteration from standard procedures. Screw positioning according to the Gertzbein and Robins classification (GR) was category A and B in 71 screws (94.7%) and one screw was revised intraoperatively (1.3%). The system was evaluated by the surgeons regarding mental load (scale 0-150), achieving average mental load for adjustment of the trajectory (70 (20-150)), installation of the drill guide (50 (10-140)) and drilling of the trajectory (20 (10-150)).

Conclusion : Navigated robot-assisted screw placement is feasible and safe. This new technique enables precise instrumentation of the complete spine, adding up to conventional neuronavigation by further automation.