Casey Tingle , 2025-04-16 17:24:00
April 16, 2025
1 min read
Key takeaways:
- Robotic-guided and CT-navigated pedicle screw placement yielded fewer malposition cases and revisions for adult spinal deformity.
- Freehand pedicle screw placement led to an all revision rate of 6%.
SAN DIEGO — Results showed robotic-guided and CT-navigated pedicle screw placement may significantly improve accuracy and reduce screw-related symptoms and revisions vs. freehand screw placement for adult spinal deformity.
Themistocles S. Protopsaltis, MD, chief of spine surgery at NYU Langone Health, and colleagues retrospectively reviewed procedural complexity, complications, 2-year revisions and screw accuracy among 237 patients with adult spinal deformity who underwent freehand, robotic-guided or CT-navigated pedicle screw placement. Researchers assessed pedicle screw placement from postoperative CT scans and used the Gertzbein-Robbins classification to measure screw accuracy.
Data were derived from Ezeonu SK, et al. Paper 433. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
“What the study showed is that when robotics or navigation was utilized, there were fewer screw malposition cases and there were fewer revisions for screw malposition,” Protopsaltis told Healio.
CT-navigated and robotic-guided pedicle screw placement had an accuracy rate of 93% and 95%, respectively, with no cortical breaches or nerve contact, according to Protopsaltis. However, he said freehand pedicle screw placement had an accuracy rate of 86%. Patients in the freehand pedicle screw placement group also had a rate of all revisions required for screw malpositioning of 6%.
When utilizing robotic guidance and CT navigation in pedicle screw placement, Protopsaltis said surgeons should not use the technology to position every screw but to place difficult screws or when more than one screw needs to be placed into the pelvis.
“We use [this technology] frequently as a reference to mark the starting point of the screw and to mark the trajectory of the screw but then we end up not using navigated instruments to cannulate the pedicle and place the screw,” he said. “It is important for surgeons to understand that the technology can be used as a check method instead of as deliberately trying to utilize the technology for every single part of placing the screw, which does tend to slow things down and, in some cases, be less accurate.”
Sources/Disclosures
Collapse
Ezeonu SK, et al. Paper 433. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
Disclosures:
Protopsaltis reports receiving intellectual property royalties from Altus; being a paid consultant for Globus Medical, Medtronic, NuVasive and Stryker; receiving research support from Medtronic; and having stock or stock options with OnePoint.