Comparing Next-Generation Robotic Technology with 3-Dimensional Computed Tomography Navigation Technology for the Insertion of Posterior Pedicle Screws

Objective: To study the differences between robot-guided (Mazor X, Mazor Robotics Ltd., Caesarea, Israel) and 3-dimensional (3D) computed tomography (CT) navigation (O-arm Surgical Imaging System, Medtronic, Minneapolis, Minnesota, USA) for the insertion of pedicle screws. Methods: We reviewed the charts of 50 patients who underwent robot-guided pedicle screw insertion (between May 2017–October 2017), and 49 patients who underwent 3D-CT navigation pedicle screw insertion (between September 2015–August 2016). Variables included were age, sex, body mass index, blood loss, length of stay, lumbar level(s), operation time, fluoroscopy time, radiation dose, accuracy, and time-per-screw placement. Results: Mean ages were 59.3 years in the robotic group and 58.2 years in the 3D-CT navigation group. Mean was 30.7 kg/m ² in the robotic group and 32.1 kg/m ² in the 3D-CT navigation group. Mean time-per-screw placement was 3.7 minutes for the robotic group and 6.8 minutes for the 3D-CT navigation group, P < 0.001. In the robotic group, 189 of 190 screws were placed with Ravi grade I accuracy, and 1 was grade II. In the 3D-CT navigation group, 157 of 165 screws were Ravi grade I, and 8 were grade II (P = 0.11). Fluoroscopy time (P < 0.001), time-per-screw placement (P < 0.001), and length of stay (P < 0.001) were significantly lower in the robotic group. Conclusions: Both technologies are safe and accurate. Robotic technology exposed patients to less fluoroscopy time, decreased time-per-screw placement and shorter hospital stay than 3D-CT navigation. Further studies are warranted to verify our results.