Instrumentation using robotics coupled with navigation in pediatric spine deformity surgery: a technical report of sacropelvic instrumentation.

Purpose: This technical report presents the intraoperative experience of using robotic-assisted navigation (RAN) for sacropelvic instrumentation in pediatric spine deformity surgery.

Methods: A retrospective review of patients who underwent surgery using RAN for sacropelvic instrumentation at a single institution from 2019 to 2022 was conducted. In cases with screw confirmation imaging, screws were evaluated using the Gertzbein and Robbins classification scale.

Results: 52 cases were included. Average age at surgery was 14.1 years and 67.3% of patients were female. The most common diagnosis was spondylolisthesis (48.1%). The average major curve in scoliosis cases was 77°. A Schanz pin in the posterior superior iliac spine was placed in 98.1% of surgeries compared to 1 case with a spinous process clamp. Intraoperative 3D imaging scans (Scan & Plan) were used for 69.2% of the robotic registrations to the patient and intraoperative fluoroscopy-CT scans were used for 30.8%. 644 total screws were placed, with 427 placed robotically. Specifically, in the sacral-pelvic region, 98 S1, 18 S2, 58 S2AI, and 5 iliac screws were placed using RAN (179 screws). In 17 cases with 139 total robotic screws, post-instrumentation intraoperative 3D imaging or postoperative CT scans were obtained. Of these screws, 99.3% (138/139; 95% CI = 95.5-99.96) were placed accurately (Grade A or Grade B). One S2AI screw had an anterior breach on intraoperative 3D imaging scan and was changed prior to closure. Loss of RAN registration was observed in 2 cases (3.8%). No cases required return to the operating room for screw malposition.

Conclusion: This study highlights high screw accuracy with no neurologic compromise associated with the use of RAN technology.