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. 2025 Apr 4:13:1491775.
doi: 10.3389/fbioe.2025.1491775. eCollection 2025.

Comparison of robotic AI-assisted and manual pedicle screw fixation for treating thoracolumbar fractures: a retrospective controlled trial

Xun Xiao #  1   2 , XingKun Wang #  1   2 , Bin Meng  1   2 , Xin Pan  1 , Hua Zhao  1
Affiliations

Comparison of robotic AI-assisted and manual pedicle screw fixation for treating thoracolumbar fractures: a retrospective controlled trial

Xun Xiao et al. Front Bioeng Biotechnol. .

Abstract

Objective: To compare the clinical efficacy and screw placement accuracy of robot artificial intelligence (AI)-assisted percutaneous screw fixation and conventional C-arm-assisted percutaneous screw fixation (manual placement) in the treatment of thoracolumbar single-segment fractures without neurological symptoms.

Methods: This study is a single-center retrospective analysis involving patients with thoracolumbar single-segment fractures without neurological symptoms. Patients were divided into Group A (robotic AI-assisted placement) and Group B (manual placement). Clinical outcomes such as operative time, intraoperative fluoroscopy frequency, screw placement accuracy, postoperative complications, length of hospital stay, and postoperative pain were compared between the two groups.

Results: Group A showed significantly better screw placement accuracy, fewer intraoperative fluoroscopy attempts, shorter fluoroscopy time, and fewer guidewire adjustments compared to Group B (P < 0.05). Additionally, Group A had shorter hospital stays, a lower incidence of postoperative complications, and short-term greater improvement in Visual Analog Scale (VAS) scores (P < 0.05). However, after 1 year of follow-up, there was no statistically significant difference between the two groups in the improvement of VAS scores.

Conclusion: Robotic AI-assisted placement improves pedicle screw placement accuracy, reduces intraoperative fluoroscopy frequency and time, alleviates postoperative pain, and accelerates patient recovery. This approach aligns with the principles of enhanced recovery in orthopedic surgery and holds promise for wider clinical application in the treatment of thoracolumbar fractures.

Keywords: assisted screw placement; manual screw placement; robotic AI-assisted navigation; safety and efficacy; thoracolumbar fractures.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Screw insertion procedure using the TiRobot system. (A) A tracker for the spinal navigation was placed on a spinous process. (B) C-arm navigation. (C) K-wire was drilled into the vertebrae. (D) Preoperative planning and design are performed in the robotic workstation. (E) All screws were implanted.
FIGURE 2
FIGURE 2
Grading of pedicle screw misplacement.
FIGURE 3
FIGURE 3
Difference in the number of fluoroscopies, fluoroscopy time,and guidewire adjustments between the two groups. Note: ***P < 0.001.
FIGURE 4
FIGURE 4
Screw placement in Group A. (A, B) Grade A screws; (C) Grade B screw; (D) Grade C screw.
FIGURE 5
FIGURE 5
Screw placement in Group B. (A) Grade A screws; (B) Grade B screws; (C) Grade C screws; (D) Grade D screws.
FIGURE 6
FIGURE 6
A 5-year-old female patient underwent robotic-assisted percutaneous pedicle screw fixation for L1 fracture reduction. All screws were classified as grade A screws based on imaging.
FIGURE 7
FIGURE 7
X -rays of a 55-year-old female patient treated with robotic-assisted percutaneous pedicle screw fixation. (A) Preoperative; (B) 3 days postoperative; (C) 6 months postoperative; (D) 1 year postoperative.
FIGURE 8
FIGURE 8
X-rays of a 69-year-old female patient treated with manual percutaneous pedicle screw fixation. (A) Preoperative; (B) 3 days postoperative; (C) 6 months postoperative; (D) 1 year postoperative.
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