Comparison of the Accuracy and Safety of TiRobot‐Assisted and Fluoroscopy‐Assisted Percutaneous Pedicle Screw Placement for the Treatment of Thoracolumbar Fractures

OBJECTIVE: Studies have compared the safety and accuracy of robot‐assisted techniques for inserting conventional open pedicle screws for spinal surgery. However, no relevant studies have confirmed that robot‐assisted percutaneous screw placement is better than fluoroscopic percutaneous screw placement for the treatment of thoracolumbar fractures. This study compared the accuracy and safety of TiRobot‐assisted percutaneous pedicle screw placement with those of the fluoroscopy‐assisted percutaneous technique for the treatment of thoracolumbar fractures. METHODS: This retrospective study included 126 patients with thoracolumbar fractures who underwent percutaneous pedicle screw placement. Sixty‐five patients were treated with the TiRobot‐assisted technique and 61 patients were treated with the fluoroscopy‐assisted technique. Patient demographics, accuracy of screw placement (according to the Gertzbein and Robbins scale of grades A to E), screw insertion angle, radiation exposure, surgical time, intraoperative blood loss, length of hospital stay, incision length, hospital expenses, surgical site infection, and neurological injury of the TiRobot‐assisted and fluoroscopy‐assisted groups were compared using Student's t‐test, Pearson χ(2) test, or Fisher's exact test. RESULTS: A total of 729 screws were placed (TiRobot‐assisted group: 374 screws; fluoroscopy‐assisted group: 355 screws). In the TiRobot‐assisted group, 82.8% of screws were optimally positioned (grade A); however, the placement grades of the remaining screws were categorized as grade B (13.3%), grade C (3.2%), and grade D (0.5%). In the fluoroscopy‐assisted group, 66.7% of the screws were optimally positioned (grade A); however, the placement grades of the remaining screws were categorized as grade B (21.4%), grade C (7.6%), grade D (3.6%), and grade E (0.5%). The proportion of clinically acceptable screws (grade A or B) was greater in the TiRobot‐assisted group than in the fluoroscopy‐assisted group. Additionally, the TiRobot‐assisted group had a significantly larger mean screw insertion angle (22.27° ± 5.48° vs 20.55° ± 5.15°), larger incision length (13.86 ± 1.24 cm vs 12.77 ± 1.43 cm), and higher hospital expenses (69061.55 ± 7166.60 yuan vs 59383.85 ± 5019.64 yuan) than the fluoroscopy‐assisted group. There were no significant differences in the intraoperative blood loss, length of hospital stay, and rates of surgical site infection and neurological injury in both groups (p > 0.05). However, the TiRobot‐assisted group had significantly better surgical times, radiation times, and radiation exposure than the fluoroscopy‐assisted group (p < 0.05). CONCLUSIONS: Percutaneous TiRobot‐assisted pedicle screw placement is a safe, useful, and potentially more accurate alternative to the percutaneous fluoroscopy‐assisted technique for treating thoracolumbar fractures.