Robotic-assisted Cervical Pedicle Screw Fixation With Custom Instruments: An Analysis of 206 Screws in 22 Patients

Study Design: Prospective study Objective: This study aims to describe a workflow and custom instruments for robotic-assisted cervical pedicle screw placement using the MazorX Stealth Edition. Summary of Background Data: Posterior cervical spinal instrumentation using pedicle screws offers biomechanical advantages but carries risks of injury to the vertebral artery and nerve roots. Fluoroscopic and navigation aids exist, yet robotic assistance for cervical pedicle screw placement lacks a defined workflow. While previous generations of spine robots have been used in placing pedicle screws, there are no papers in literature that described the use of third-generation spine robots in placing them. Methods: Twenty-two patients undergoing cervical pedicle screw placement with custom instruments and robotic assistance were included. Screw trajectories were planned and executed by the robotic arm, with postoperative O-arm scans assessing accuracy. Clinical and radiologic outcomes at 3-month follow-up were measured. Results: A total of 206 screws were placed with a 98.1% accuracy rate. Four screws breached the pedicle without resulting in nerve root injury. Average surgical time was 190 minutes, with 6 minutes per screw insertion. Blood loss averaged 180 mL. NDI scores improved from 42.3 to 28.2. Complications included superficial wound infections in 2 patients, deep wound infection in 1, and 1 nondominant vertebral artery injury. Conclusions: Robotic-assisted cervical pedicle screw placement demonstrates high accuracy and significant clinical improvements, validating the workflow and custom instruments developed.