The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 14, 2020

Comparative Retrospective Analysis of Accuracy of Robotic-Guided versus Fluoroscopy-Guided Percutaneous Pedicle Screw Placement in Adults with Degenerative Spine Disease

Zahrawi Faissal1, *, Manzi Brian2, Sager Jill1
1 Florida Hospital, Celebration, FL, USA
2 University of Central Florida, Orlando, FL, USA



Robotic-guidance for pedicle screws can reportedly increase placement accuracies and surgical efficiencies especially in percutaneous approaches.


The study aimed to compare the accuracy of percutaneous pedicle screw placement and post-operative course of robotic-guidance versus fluoroscopy-guidance performed by a surgeon experienced in performing fluoroscopy-guided MIS spinal fusions.

Study Design:

This is a retrospective medical chart review of 2 cohorts of consecutive patients operated by the same surgeon.


Medical records of adults suffering from degenerative spine disease treated by percutaneous spinal fusion surgeries with robotic-guidance vs. fluoroscopy-guidance were reviewed. Endpoints included pedicle screw placement accuracy (on post-operative CTs) and surgical complications and revisions.


Ninety-nine patients were reviewed in each arm which were similar in demographics and surgical indications. The robotic arm had 5.8 screws per case on average and 6.0 in the control arm (p=0.65). No significant differences were found in postoperative complication rates revision surgeries length of stay duration of surgery screw implantation times blood loss or results of Oswestry Disability Index questionnaires.

Post-operative CTs were available for 52 patients (293 screws) in the robotic arm and 70 (421 screws) in the freehand controls. In the robotic arm 100% of screws were found accurately placed within the “safe zone” vs. 410 screws (97.4%) in the control arm (p=0.005). Of 11 breaching screws in the control arm one breached by 6mm but the patient did not suffer from any sequelae (12-month follow-up). The average follow up period was 9.2±4 months in the robotic-guided arm and 10.5±3 in the control arm. There were no significant differences in complications or revisions.


A modest yet statistically significant increase in pedicle screw placement accuracy was observed with robotic-guidance compared to freehand. Larger prospective studies are needed to demonstrate differences in clinical outcomes.

Keywords: Percutaneous fusion, Pedicle screws, Robotic-guidance, Placement accuracy, Spine, Surgical.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 576
Last Page: 582
Publisher Id: TOORTHJ-12-576
DOI: 10.2174/1874325001812010576

Article History:

Received Date: 07/09/2018
Revision Received Date: 07/11/2018
Acceptance Date: 19/11/2018
Electronic publication date: 31/12/2018
Collection year: 2018

© 2018 Faissal et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faissal Zahrawi, MD, 400 Celebration Pl. a280, Celebration, FL 34747, USA;

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