Impact of surgeon experience on the safety and accuracy of robot-assisted vs. navigation-guided percutaneous pedicle screw placement: a matched cohort study

Purpose To compare intraoperative screw revision and outcomes of robot-assisted versus navigation-guided percutaneous pedicle screw placement and to explore whether outcomes differed by surgeon experience. Materials and methods A prospective cohort of 43 consecutive patients undergoing robot-assisted percutaneous pedicle screw fixation between September 2024 and March 2026 was compared with a matched historical cohort of 129 patients treated using navigated conventional percutaneous instrumentation. Propensity score matching included age, sex, ASA physical status, anatomical region, surgical indication, and surgeon expertise. Surgeons were stratified according to prior spondylodesis case volume. Outcomes included screw revision rates (as a measure of screw accuracy), screw placement time, operative time, blood loss, and perioperative complications. Results Unadjusted screw-level revision proportions were 2.3% with robotic assistance and 3.5% with navigation-guided instrumentation. In adjusted patient-level analysis, greater surgeon experience, but not robotic assistance, was associated with fewer revisions. In the lowest-experience group, the proportions were descriptively 4.3% and 8.2%, but the technique-by-experience interaction was not statistically significant. Median screw-placement time was longer with robotic assistance (7.8 vs. 5.5 min per screw, p < 0.001). No statistically significant between-group differences were detected in blood loss, length of stay, or complication rates. Conclusion Robot-assisted pedicle screw placement is safe and accurate, with comparable complication rates to conventional navigation. The observed increase in screw placement time may reflect the early adaptation phase of the robotic technique rather than an inherent limitation of the system. The descriptive reduction in revision rates among less experienced surgeons suggests a potential role for robotic assistance in supporting standardization and surgical training; however, this exploratory finding warrants confirmation in larger studies.