Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement

Abstract

Background Robot-assisted spine surgery aims to improve the accuracy of screw placement. We compared the accuracy and safety between a novel robot and free hand in thoracolumbar pedicle screw placement. Methods Eighty patients scheduled to undergo robot-assisted (40 patients) and free-hand (40 patients) pedicle screw placement were included. The patients’ demographic characteristics, radiographic accuracy, and perioperative outcomes were compared. The accuracy of screw placement was based on cortical violation and screw deviation. Safety outcomes mainly included operative time, blood loss, revision, and complications. Results A total of 178 and 172 screws were placed in the robot-assisted and free-hand groups, respectively. The rate of perfect screw position (grade A) was higher in the robot-assisted group than in the free-hand group (91.0% vs. 75.6%; P < 0.001). The rate of clinically acceptable screw position (grades A and B) was also higher in the robot-assisted group than in the free-hand group (99.4% vs. 90.1%; P < 0.001). The robot-assisted group had significantly lower screw deviation than the free-hand group [1.46 (0.94, 1.95) mm vs. 2.48 (1.09, 3.74) mm, P < 0.001]. There was no robot abandonment in the robot-assisted group. No revision was required in any of the groups. Conclusions Robot-assisted pedicle screw placement is more accurate than free-hand placement. The second-generation TiRobot–assisted thoracolumbar pedicle screw placement is an accurate and safe procedure. Trial registration retrospectively registered

Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate

“…In recent years, there have been many studies on the robot's advantage in accuracy and selection of pedicle screws, offering benefits for both patients and surgeons [15,[19][20][21]. Preoperative CT is used to plan screw trajectories, and intraoperative fluoroscopy is applied to register images.…”

The clinical application of artificial intelligence technology in spinal surgery

“…[47][48][49] The study conducted by Tian et al revealed that the TiRobot® system considerably enhanced the precision and security of pedicle screw fixation without extending the surgical duration or exacerbating complications, indicating its substantial potential for clinical use. [50] In their another investigation of the TiRobot II, their results demonstrated that robot-assisted pedicle screw placement surpasses free-hand methods in accuracy and TiRobot-assisted thoracolumbar pedicle screw placement is a reliable and safe technique [51] .…”

Analysis of guide wire displacement in robot-assisted spinal pedicle screw implantation

“…Robot navigation technology has significantly improved the excellent rate of pedicle screw placement due to its stable and accurate characteristics, showing excellent safety and accuracy. Robot-assisted screw placement has been reported to be excellent in 94.5–98.7% [ 1 – 5 ]. The excellent rate of free-hand pedicle screw placement ranged from 25.0 to 93.5% [ 2 , 5 , 6 ].…”

“…Robot-assisted screw placement has been reported to be excellent in 94.5–98.7% [ 1 – 5 ]. The excellent rate of free-hand pedicle screw placement ranged from 25.0 to 93.5% [ 2 , 5 , 6 ]. The accuracy of screw placement varies significantly between physicians, and the accuracy of screw placement is closely related to the physician's proficiency.…”