{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:47:04Z","timestamp":1792514824737,"version":"4.5.0"},"reference-count":73,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab\u2019s Cirq\u00ae surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq\u00ae Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 \u00b1 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 \u00b1 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 \u00b1 02:11 min (p &lt; 0.05). Mean entry point deviation was 1.9 \u00b1 1.23 mm, mean deviation from the tip of the screw was 2.61 \u00b1 1.6 mm and mean angular deviation was 3.5\u00b0 \u00b1 2\u00b0. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab\u2019s Cirq\u00ae Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.<\/jats:p>","DOI":"10.3390\/jcm10245725","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T11:00:23Z","timestamp":1638874823000},"page":"5725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq\u00ae Robotic Alignment: An Evaluation of the First 70 Screws"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-5589","authenticated-orcid":false,"given":"Mirza","family":"Pojski\u0107","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-7572","authenticated-orcid":false,"given":"Miriam","family":"Bopp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany"},{"name":"Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8216-9410","authenticated-orcid":false,"given":"Christopher","family":"Nimsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany"},{"name":"Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Carl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany"},{"name":"Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany"},{"name":"Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2855-3443","authenticated-orcid":false,"given":"Benjamin","family":"Sa\u03b2","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1097\/BRS.0b013e3182a62527","article-title":"Perioperative complications and mortality after spinal fusions: Analysis of trends and risk factors","volume":"38","author":"Goz","year":"2013","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s11701-019-01007-z","article-title":"Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: An evaluation of the first 54 cases","volume":"14","author":"Benech","year":"2020","journal-title":"J. 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