{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:07:04Z","timestamp":1779527224854,"version":"3.53.1"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n An increasing number of studies have shown that a robotic guidance system (RGS) can provide accurate cervical pedicle screw (CPS) placement. The accuracy of CPS placement with an RGS has mostly been evaluated according to the magnitude of pedicular cortical violation. However, an RGS assists in pedicle screw (PS) placement by directly indicating the preplanned trajectory in the operative field. Therefore, investigating how accurately the planned trajectory is executed is essential to determine the accuracy of CPS placement using an RGS, in addition to evaluating the clinical accuracy. Hence, this study aimed to evaluate the accuracy of CPS placement using an RGS by comparing the executed trajectory with the planned trajectory.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This prospective study analyzed 174 CPSs placed between C2 and C6 in 39 consecutive patients who underwent cervical fusion surgery using an RGS. The deviation of the executed CPS trajectory from the planned trajectory was measured at the entry point and at a depth of 20 mm in both the axial and sagittal planes on CT images. Additionally, its direction was noted (lateral or medial in the axial plane and cephalad or caudal in the sagittal plane). These measurements were analyzed according to spinal levels (C2 and C3\u2013C6), laterality (right and left sides), and registration material (preoperative and intraoperative CT images). Furthermore, clinical accuracy was assessed using the Neo classification (grades 0\u20133).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Overall, the mean (\u00b1 SD) deviations from the planned trajectory at the entry point and at a depth of 20 mm were 0.79 \u00b1 0.65 mm and 0.86 \u00b1 0.69 mm in the axial plane and 0.88 \u00b1 0.81 mm and 0.82 \u00b1 0.79 mm in the sagittal plane, respectively. When separately examining the deviations according to spinal level, laterality, and registration material, the mean deviations were < 1 mm at any point. Analysis of the deviation direction showed that the CPSs were placed divergently from the planned trajectory in the axial plane. In the sagittal plane, the CPSs were likely to be inserted parallel to the planned trajectory. However, at C2 the CPSs were placed in the caudal direction relative to the planned trajectory. Regarding clinical accuracy, the acceptable rates (grades 0 and 1) were 97.7% and 97.1% in the axial and sagittal planes, respectively, without any CPS-related complications.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study suggests that an RGS can reliably execute planned trajectories, aiding accurate CPS placement in clinical settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.9.focus24431","type":"journal-article","created":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T08:25:10Z","timestamp":1733041510000},"page":"E13","source":"Crossref","is-referenced-by-count":5,"title":["Accuracy of cervical pedicle screw placement with a robotic guidance system via the open midline approach"],"prefix":"10.3171","volume":"57","author":[{"given":"Yuki","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Fujishiro","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiya","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromichi","family":"Hirai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachio","family":"Hayama","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitada","family":"Usami","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Neo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Spinal Disord","first-page":"19","article-title":"Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report","volume":"7","author":"Abumi K","year":"1994","unstructured":"Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord. 1994;7(1):19\u201328."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"977","article-title":"Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison","volume":"22","author":"Jones EL","year":"1997","unstructured":"Jones EL, Heller JG, Silcox DH, Hutton WC. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976). 1997;22(9):977\u2013982."},{"issue":"6","key":"b3","series-title":"Spine J","first-page":"667","article-title":"Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths","volume":"6","author":"Johnston TL","year":"2006","unstructured":"Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D. Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J. 2006;6(6):667\u2013672."},{"issue":"5","key":"b4","series-title":"J Neurosurg Spine","first-page":"614","article-title":"Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review","volume":"19","author":"Yoshihara H","year":"2013","unstructured":"Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine. 2013;19(5):614\u2013623."},{"issue":"22","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2510","article-title":"Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle","volume":"29","author":"Sakamoto T","year":"2004","unstructured":"Sakamoto T, Neo M, Nakamura T. Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine (Phila Pa 1976). 2004;29(22):2510\u20132515."},{"issue":"1","key":"b6","series-title":"J Neurosurg Spine","first-page":"52","article-title":"The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood","volume":"13","author":"Tomasino A","year":"2010","unstructured":"Tomasino A, Parikh K, Koller H, The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood. J Neurosurg Spine. 2010;13(1):52\u201360."},{"key":"b7","series-title":"World Neurosurg","first-page":"e22","article-title":"Determination of availability of safety margin for placement of C3-C6 pedicle screw on CT angiography","volume":"157","author":"Sharma D","year":"2022","unstructured":"Sharma D, Sawarkar DP, Singh PK, Determination of availability of safety margin for placement of C3-C6 pedicle screw on CT angiography. World Neurosurg. 2022;157:e22\u2013e28."},{"issue":"8","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"962","article-title":"Complications of pedicle screw fixation in reconstructive surgery of the cervical spine","volume":"25","author":"Abumi K","year":"2000","unstructured":"Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 2000;25(8):962\u2013969."},{"issue":"9","key":"b9","series-title":"Eur Spine J","first-page":"1293","article-title":"Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope","volume":"18","author":"Yukawa Y","year":"2009","unstructured":"Yukawa Y, Kato F, Ito K, Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009;18(9):1293\u20131299."},{"issue":"24","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2800","article-title":"The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae","volume":"30","author":"Neo M","year":"2005","unstructured":"Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976). 2005;30(24):2800\u20132805."},{"issue":"2","key":"b11","series-title":"Spine J","first-page":"371","article-title":"The medial cortical pedicle screw\u2014a new technique for cervical pedicle screw placement with partial drilling of medial cortex","volume":"14","author":"Mahesh B","year":"2014","unstructured":"Mahesh B, Upendra B, Mahan RS. The medial cortical pedicle screw\u2014a new technique for cervical pedicle screw placement with partial drilling of medial cortex. Spine J. 2014;14(2):371\u2013380."},{"issue":"4","key":"b12","series-title":"Tomography","first-page":"614","article-title":"Cervical spine pedicle screw accuracy in fluoroscopic, navigated and template guided systems\u2014a systematic review","volume":"7","author":"Mahmoud A","year":"2021","unstructured":"Mahmoud A, Shanmuganathan K, Rocos B, Sedra F, Montgomery A, Aftab S. Cervical spine pedicle screw accuracy in fluoroscopic, navigated and template guided systems\u2014a systematic review. Tomography. 2021;7(4):614\u2013622."},{"issue":"6","key":"b13","series-title":"Clin Biomech (Bristol, Avon)","first-page":"293","article-title":"Clinical evaluation of a system for precision enhancement in spine surgery","volume":"10","author":"Nolte LP","year":"1995","unstructured":"Nolte LP, Zamorano L, Visarius H, Clinical evaluation of a system for precision enhancement in spine surgery. Clin Biomech (Bristol, Avon). 1995;10(6):293\u2013303."},{"issue":"3)(suppl","key":"b14","series-title":"J Neurosurg","first-page":"257","article-title":"Improved accuracy of computer-assisted cervical pedicle screw insertion","volume":"99","author":"Kotani Y","year":"2003","unstructured":"Kotani Y, Abumi K, Ito M, Minami A. Improved accuracy of computer-assisted cervical pedicle screw insertion. J Neurosurg. 2003;99(3)(suppl):257\u2013263."},{"issue":"6","key":"b15","series-title":"Rheumatol Int","first-page":"567","article-title":"Efficacy of computer-assisted pedicle screw insertion for cervical instability in RA patients","volume":"27","author":"Ito H","year":"2007","unstructured":"Ito H, Neo M, Yoshida M, Fujibayashi S, Yoshitomi H, Nakamura T. Efficacy of computer-assisted pedicle screw insertion for cervical instability in RA patients. Rheumatol Int. 2007;27(6):567\u2013574."},{"issue":"1","key":"b16","series-title":"Orthop Surg","first-page":"52","article-title":"Analysis of accuracy of computer-assisted navigation in cervical pedicle screw installation","volume":"3","author":"Zhang HL","year":"2011","unstructured":"Zhang HL, Zhou DS, Jiang ZS. Analysis of accuracy of computer-assisted navigation in cervical pedicle screw installation. Orthop Surg. 2011;3(1):52\u201356."},{"issue":"11","key":"b17","series-title":"Eur Spine J","first-page":"2729","article-title":"Cervical pedicle screw instrumentation is more reliable with O-arm-based 3D navigation: analysis of cervical pedicle screw placement accuracy with O-arm-based 3D navigation","volume":"27","author":"Chachan S","year":"2018","unstructured":"Chachan S, Bin Abd Razak HR, Loo WL, Allen JC, Shree Kumar D. 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J Clin Med. 2021;10(24):5725."},{"issue":"11","key":"b33","series-title":"Ann Biomed Eng","first-page":"2518","article-title":"Pedicle screw placement accuracy in robot-assisted spinal fusion in a multicenter study","volume":"51","author":"Volk VL","year":"2023","unstructured":"Volk VL, Steele KA, Cinello-Smith M, Pedicle screw placement accuracy in robot-assisted spinal fusion in a multicenter study. Ann Biomed Eng. 2023;51(11):2518\u20132527."},{"issue":"2","key":"b34","series-title":"Global Spine J","first-page":"196","article-title":"Spinal navigation for cervical pedicle screws: surgical pearls and pitfalls","volume":"11","author":"Gan G","year":"2021","unstructured":"Gan G, Kaliya-Perumal AK, Yu CS, Nolan CP, Oh JY. Spinal navigation for cervical pedicle screws: surgical pearls and pitfalls. Global Spine J. 2021;11(2):196\u2013202."},{"key":"b35","series-title":"World Neurosurg","first-page":"e460","article-title":"Benefits and pitfalls of O-arm navigation in cervical pedicle screw","volume":"159","author":"Shin HK","year":"2022","unstructured":"Shin HK, Jeon SR, Roh SW, Park JH. Benefits and pitfalls of O-arm navigation in cervical pedicle screw. World Neurosurg. 2022;159:e460\u2013e465."},{"issue":"8","key":"b36","series-title":"Acta Neurochir (Wien)","first-page":"1343","article-title":"Vertebral rotation during pedicle screw insertion in patients with cervical injury","volume":"152","author":"Sugimoto Y","year":"2010","unstructured":"Sugimoto Y, Ito Y, Tomioka M, Vertebral rotation during pedicle screw insertion in patients with cervical injury. Acta Neurochir (Wien). 2010;152(8):1343\u20131346."},{"issue":"3","key":"b37","series-title":"HSS J","first-page":"308","article-title":"Overview of robotic technology in spine surgery","volume":"17","author":"Alluri RK","year":"2021","unstructured":"Alluri RK, Avrumova F, Sivaganesan A, Vaishnav AS, Lebl DR, Qureshi SA. Overview of robotic technology in spine surgery. HSS J. 2021;17(3):308\u2013316."},{"issue":"1","key":"b1","series-title":"J Spinal Disord","first-page":"19","article-title":"Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report","volume":"7","author":"Abumi K","year":"1994","unstructured":"Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord. 1994;7(1):19\u201328."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"977","article-title":"Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison","volume":"22","author":"Jones EL","year":"1997","unstructured":"Jones EL, Heller JG, Silcox DH, Hutton WC. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976). 1997;22(9):977\u2013982."},{"issue":"6","key":"b3","series-title":"Spine J","first-page":"667","article-title":"Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths","volume":"6","author":"Johnston TL","year":"2006","unstructured":"Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D. Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J. 2006;6(6):667\u2013672."},{"issue":"5","key":"b4","series-title":"J Neurosurg Spine","first-page":"614","article-title":"Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review","volume":"19","author":"Yoshihara H","year":"2013","unstructured":"Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine. 2013;19(5):614\u2013623."},{"issue":"22","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2510","article-title":"Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle","volume":"29","author":"Sakamoto T","year":"2004","unstructured":"Sakamoto T, Neo M, Nakamura T. Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine (Phila Pa 1976). 2004;29(22):2510\u20132515."},{"issue":"1","key":"b6","series-title":"J Neurosurg Spine","first-page":"52","article-title":"The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood","volume":"13","author":"Tomasino A","year":"2010","unstructured":"Tomasino A, Parikh K, Koller H, The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood. J Neurosurg Spine. 2010;13(1):52\u201360."},{"key":"b7","series-title":"World Neurosurg","first-page":"e22","article-title":"Determination of availability of safety margin for placement of C3-C6 pedicle screw on CT angiography","volume":"157","author":"Sharma D","year":"2022","unstructured":"Sharma D, Sawarkar DP, Singh PK, Determination of availability of safety margin for placement of C3-C6 pedicle screw on CT angiography. World Neurosurg. 2022;157:e22\u2013e28."},{"issue":"8","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"962","article-title":"Complications of pedicle screw fixation in reconstructive surgery of the cervical spine","volume":"25","author":"Abumi K","year":"2000","unstructured":"Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 2000;25(8):962\u2013969."},{"issue":"9","key":"b9","series-title":"Eur Spine J","first-page":"1293","article-title":"Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope","volume":"18","author":"Yukawa Y","year":"2009","unstructured":"Yukawa Y, Kato F, Ito K, Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009;18(9):1293\u20131299."},{"issue":"24","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2800","article-title":"The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae","volume":"30","author":"Neo M","year":"2005","unstructured":"Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976). 2005;30(24):2800\u20132805."},{"issue":"2","key":"b11","series-title":"Spine J","first-page":"371","article-title":"The medial cortical pedicle screw\u2014a new technique for cervical pedicle screw placement with partial drilling of medial cortex","volume":"14","author":"Mahesh B","year":"2014","unstructured":"Mahesh B, Upendra B, Mahan RS. The medial cortical pedicle screw\u2014a new technique for cervical pedicle screw placement with partial drilling of medial cortex. 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