Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study

Objective: The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery. Methods: A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the ro-botic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS). Results: A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95. 16%. The average error of entry offset was 2. 86 mm, target offset was 2. 48 mm, depth offset was 1. 99 mm, and angular offset was 3. 07°. According to the GRS grading system, 88. 39% of the screws were classified as grade A, 9. 60% as grade B, 1. 56% as grade C, 0. 22% as grade D, and 0. 22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97. 54% of the total, with no reported neurologic complications. Conclusion: Our study demonstrated that pedicle screw insertion using the novel robot-as-sisted navigation method is both accurate and safe. Further prospective studies are neces-sary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.