Accuracy of Robotic-Guided Pedicular Screw Insertion in Thoracolumbar Spinal Surgery.

Background/Objectives: Screw placement accuracy with robotic guidance shows better results than freehand techniques, yet there is scant data for region-specific outcomes, fusion rates, and complication profiles in different populations. The purpose of this study is to assess and describe screw-rod accuracy, fusion rates, and complications of robot-assisted pedicle screw placement in a Spanish cohort. Methods: Robotic-guided technique for thoracolumbar fusion in 115 patients (July 2020-January 2025) using ExcelsiusGPS® platform (Globus Medical Inc., Audubon, PA, USA). Inclusion criteria: adults (≥18 years) with postoperative CT to assess accuracy. Primary outcomes were screw accuracy (assessed on the Gertzbein-Robbins scale), fusion rates, and complications (infection, osteolysis, and subsidence). Jamovi 2.6 was employed for statistical analysis. Results: Of a total of 726 screws implanted, 590 screws (95 patients) were studied: 584 (99%) Grade A, 5 (0.8%) Grade B, and 1 (0.2%) Grade C. Fusion was achieved in 85 out of 95 patients (89.5%). Complications included superficial infections (3/115 patients, 2.6%) and asymptomatic osteolysis (8/95 patients, 8.4%, mostly at S1). There was no screw subsidence or removal. Conclusions: Robotic-guided pedicle screw placement demonstrated exceptional accuracy (99% Grade A), high fusion success (89.5%), and minimal complications in this Spanish cohort, supporting its clinical utility for spinal instrumentation.