To study pedicle screw placement, complication rate, radiation exposure, and potential technology failure in adult patients undergoing robotic-navigated spinal surgery for degenerative thoracic and lumbar disorders. 

A single-center prospectively collected data series of patients referred for spinal surgery with robot-navigated assistance (RNA) between 2019 – 2022. Post-instrumentation intraoperative 3D fluoroscopy scans were performed in all patients and screw positioning was compared to pre-operative plan to assess reliability, accuracy, and risk factors for malposition. Clinical and intraoperative data, radiation time, and radiation exposure were recorded.

A total of 1129 pedicle screws were implanted in 196 adult patients over the 3-year study period. Screws were placed robotically in 1001 (89%), converted from robotic placement to k-wire or freehand technique in 66 (6%), and planned and inserted freehand in 60 (5%). Of the robotically placed screws 94.1% were determined to be GRS Grade A with median deviation from preoperative planning templates of 1.1 ± 1.2 mm. Breaches (?2 mm exceeding pedicle cortex) were registered in 19 (5.1%) of screws. Skive events were noted in 20 screws (1.8%) due to hypoplastic pedicles, unfavorable morphology of screw starting point, and soft-tissue pressure on the robotic cannula. Complete robot abandonment was recorded in three patients (1.5%). In cases with suboptimal screw position noted on intraoperative 3D scan, implants were re-positioned in all cases uneventfully. There were no durotomies, neurological deficits, or returns to the operating room related to implant positioning in any patient.

RNA allows for high accuracy and reliability of screw placement in the thoracic and lumbar spine with a low rate of complications. Identification of patient anatomical features that may make suboptimal screw position more likely will aid in future implementation of robotic surgical techniques.