Abstract
OBJECTIVE: This retrospective single-center study aimed to compare the accuracy and revision rates of pedicle screw (PS) placement using robot-guided (RG), intraoperative CT-navigated (iCT-nav), and fluoroscopy-guided (FG) techniques. Additionally, screw loosening and overall revision rates were assessed across all three methods. METHODS: Data from 237 consecutive patients who underwent PS placement using iCT-nav, FG, or RG were analyzed. Each PS was evaluated in intraoperative or postoperative CT and classified using the Gertzbein-Robbins Scale (GRS). Follow-up CT to assess fusion and screw loosening was performed at a median of 8 months (IQR = 5-17). RESULTS: A total of 1352 PS were placed: 444 with RG, 667 with FG, and 241 with iCT-nav. RG showed the highest rate of GRS A screws (91.7 %) compared to iCT-nav (86.2 %) and FG (80.5 %). The iCT-nav group had the lowest revision rate due to loosening (p < 0.001), while the FG group showed the highest revision rates due to misplacement (p < 0.001) and loosening (p = 0.001). Radiation exposure (effective dose, ED) was significantly lower in the iCT group compared to the FG group. CONCLUSION: RG PS placement demonstrates superior accuracy compared to iCT-nav and FG. Furthermore, intraoperative CT imaging significantly reduces total radiation exposure for patients.