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September 6, 2026European Spine JournalOpen Access

The accuracy of navigated vs. robot-assisted pedicle screw placement in spine surgery: a retrospective single-centre comparative study

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Authors

AMAli MulhemUniversity of OxfordLSLennart SchreiweisBundeswehrzentralkrankenhaus KoblenzHKHarald KrenzlinJohannes Gutenberg University Mainz

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Implication

Retrospective cohort study finds equivalent screw accuracy between robotic and navigated spine surgery in surgical patients, indicating distinct trade-offs in radiation and registration success.

Key Points

  • To compare pedicle screw placement accuracy and safety between robot-assisted and navigation-guided surgery, alongside evaluating intraoperative 3D-fluoroscopy versus preoperative CT surface-matching registration.
  • Retrospective comparative cohort study of 268 consecutive patients receiving 1,718 pedicle screws (728 robot-assisted, 990 navigation-guided) at a single department between 2018 and 2022.
  • Graded screw accuracy on postoperative CT using a 0–4 ordinal scale (Grades 3–4 indicating clinically relevant malpositions) with generalized estimating equations adjusting for patient clustering and covariates.
  • Screw grade did not differ significantly between navigation-guided and robot-assisted placement (aOR 0.87, 95% CI 0.50–1.53; p = 0.632), with Grade 3–4 malpositions occurring in 9.4% vs. 11.7% of screws.
  • Robot-assisted placement had significantly lower radiation exposure and fluoroscopy time (p < 0.001) than surface matching and 3D-fluoroscopy.
  • Registration failure was higher in robot-assisted cases (10.2% [12/118]) than navigation-guided cases (1.3% [2/150]), while one neurological deficit occurred in the robot-assisted group versus none in the navigation group.

Cite This Study

Mulhem et al. (2026) studied this question.

synapsesocial.com/papers/6a9d1eb628139818eab21cffhttps://doi.org/10.1007/s00586-026-10311-w
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Automatic image registration on intraoperative CBCT compared to Surface Matching registration on preoperative CT for spinal navigation: accuracy and workflow2024 · 13 citations
  2. 2Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws2017 · 146 citations
  3. 3Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry2021 · 63 citations
  4. 4Accuracy of Pedicular Screw Placement In Vivo1990 · 1,418 citations
  5. 5Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement2011 · 411 citations