Screw Insertion Time, Fluoroscopy Time, and Operation Time for Robotic-Assisted Lumbar Pedicle Screw Placement Compared With Freehand Technique

Introduction The purpose of this study was to clarify the superiority of robotic-assisted lumbar pedicle screw placement in terms of screw insertion time, fluoroscopy time, and operation time. Methods The subjects were 46 patients who underwent a posterior lumbar interbody fusion with an open procedure for lumbar degenerative disease from April 2021 to February 2022. The robot group contained 29 cases of screw insertion using a spine robotic system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland). The freehand group contained 17 cases of screw insertion with the freehand technique utilizing the conventional C-arm image guidance. The screw insertion time, fluoroscopy time, and operation time were compared between the robot and the freehand group. Results The screw insertion time did not differ significantly between the two groups (robot group: 179.0 +/- 65.2 sec; freehand group: 164.2 +/- 83.4 sec; p = 0.507). The fluoroscopy time was significantly shorter in the robot group (robot group: 28.3 +/- 25.8 sec; freehand group: 67.5 +/- 72.8 sec; p = 0.011). The fluoroscopy time per segment was also significantly shorter in the robot group (robot group: 17.8 +/- 23.0 sec; freehand group: 60.2 +/- 74.8 sec; p = 0.007). The operation time was significantly longer in the robot group (robot group: 249.6 +/- 72.5 min; freehand group: 195.8 +/- 60.1 sec; p = 0.013), but the operation time per segment did not differ significantly between the two groups (robot group: 144.1 +/- 39.0 min; freehand group: 159.7 +/- 34.4 min; p = 0.477). Conclusions The screw insertion time and operation time per segment were similar when employing the spine robotic system compared to the freehand technique; however, the fluoroscopy time was shorter. The fluoroscopy time per segment in the robot group was 29.6% of the time of the freehand group using the C-arm. The surgeon's radiation exposure is thought to be decreased since the spine robotic system shortens the fluoroscopy time.