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.
Reza et al. (Mon,) studied this question.