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<p>To assess a robotic-assisted system versus open manual techniques to: (1) compare pedicle screw accuracy between fellows and attendings with and without robotic assistance, and (2) evaluate executed versus planned trajectory fidelity relative to prior reports. Robotic-assisted spine systems aim to improve the accuracy, reproducibility, and safety of pedicle screw placement. Limited evidence compares outcomes across differing surgeon experience levels. A total of 255 thoracolumbar pedicle screws were placed in synthetic torsos simulating adult degenerative anatomy. Four surgeons (two fellows, two attendings) each placed half their screws using open fluoroscopy-guided techniques and half using a minimally invasive percutaneous approach with the Mako Spine system and intraoperative CT-based planning. Postoperative CT and the Gertzbein-Robbins classification were used to assess accuracy. Optimal placement (Grade A), breach rates, and positional/angular deviation from planned trajectories were recorded. The robotic cohort achieved a higher rate of clinically acceptable screw placement compared with the manual cohort, although this difference was not statistically significant (124/127, 97.6% vs. 120/128, 93.8%; <i>P</i> = 0.223). Fellows and attendings both achieved high clinically acceptable screw placement rates using robotics (63/64, 98.4% vs. 61/63, 96.8%). Among fellows, robotic assistance increased optimal screw placement compared with the manual technique (53/64, 82.8% vs. 41/64, 64.1%; <i>P</i> &lt; 0.05). Robotic screws demonstrated low mean deviations from planned trajectories (1.4 ± 0.9&#xa0;mm positional, 1.7 ± 1.1° angular). The Mako Spine system enabled precise screw placement and narrowed performance gaps for less experienced surgeons. It shows promise as both training tool and means to standardize outcomes.</p>

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Robotic-assisted pedicle screw placement achieves high accuracy and narrows the experience gap: a preclinical evaluation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月1日

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  • Anna T. Reza,
  • Matthias Walper,
  • Mitchell K. Ng,
  • Paul G. Mastrokostas,
  • Andrew S. Lee,
  • Rafael G. de Oliveira,
  • Kornelis A. Poelstra,
  • John K. Ratliff,
  • Rajiv K. Sethi,
  • Michael A. Mont

摘要

To assess a robotic-assisted system versus open manual techniques to: (1) compare pedicle screw accuracy between fellows and attendings with and without robotic assistance, and (2) evaluate executed versus planned trajectory fidelity relative to prior reports. Robotic-assisted spine systems aim to improve the accuracy, reproducibility, and safety of pedicle screw placement. Limited evidence compares outcomes across differing surgeon experience levels. A total of 255 thoracolumbar pedicle screws were placed in synthetic torsos simulating adult degenerative anatomy. Four surgeons (two fellows, two attendings) each placed half their screws using open fluoroscopy-guided techniques and half using a minimally invasive percutaneous approach with the Mako Spine system and intraoperative CT-based planning. Postoperative CT and the Gertzbein-Robbins classification were used to assess accuracy. Optimal placement (Grade A), breach rates, and positional/angular deviation from planned trajectories were recorded. The robotic cohort achieved a higher rate of clinically acceptable screw placement compared with the manual cohort, although this difference was not statistically significant (124/127, 97.6% vs. 120/128, 93.8%; P = 0.223). Fellows and attendings both achieved high clinically acceptable screw placement rates using robotics (63/64, 98.4% vs. 61/63, 96.8%). Among fellows, robotic assistance increased optimal screw placement compared with the manual technique (53/64, 82.8% vs. 41/64, 64.1%; P < 0.05). Robotic screws demonstrated low mean deviations from planned trajectories (1.4 ± 0.9 mm positional, 1.7 ± 1.1° angular). The Mako Spine system enabled precise screw placement and narrowed performance gaps for less experienced surgeons. It shows promise as both training tool and means to standardize outcomes.