{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T22:48:35Z","timestamp":1784933315233,"version":"3.55.0"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"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\/Objectives: Reliable intraoperative imaging is essential for robotic-assisted (RA) pedicle screw placement. Mobile intraoperative cone-beam CT (iCBCT) systems like Loop-X have been introduced into RA workflows, but implementation data remain limited. We evaluated whether Loop-X introduction was associated with efficiency or safety, and whether associations differed by surgeon experience. Methods: We performed a retrospective epoch-based cohort study of 146 patients undergoing RA pedicle screw placement using 3D C-arm navigation (3D-BV) or Loop-X iCBCT. Outcomes were operating room (OR) time, estimated blood loss (EBL), and length of stay (LOS). The safety endpoint was 30-day complications (Clavien\u2013Dindo grade III or higher). Multivariable regression models adjusted for patient- and procedure-related covariates; the complication model was kept parsimonious because of the limited number of events. Interaction terms tested surgeon experience. Results: After adjustment, implementation phase was not independently associated with OR time (\u03b2 30.76 min, 95% CI \u221231.97 to 93.48; p = 0.33), EBL (\u03b2 \u221219.94 mL, 95% CI \u2212287.01 to 247.14; p = 0.88), or LOS (\u03b2 3.21 days, 95% CI \u22123.31 to 9.72; p = 0.33). No significant interaction with surgeon experience was detected. Major complications occurred in 16 of 146 cases (11.0%) and were not associated with Loop-X implementation (OR 0.41, 95% CI 0.10\u20131.74; p = 0.224). Patient factors and procedural complexity were the main determinants of outcomes. Conclusions: In this cohort, Loop-X implementation in an RA pedicle screw program was not associated with deterioration in perioperative efficiency or short-term safety after adjustment. These findings support feasibility in practice, but do not establish superiority, equivalence, or imaging-specific effects.<\/jats:p>","DOI":"10.3390\/jcm15103749","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T16:26:37Z","timestamp":1778689597000},"page":"3749","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of Intraoperative Cone-Beam CT (Loop-X) in an Established Robotic-Assisted Pedicle Screw Program: An Epoch-Based Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-3771","authenticated-orcid":false,"given":"Julien N.","family":"Jost","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Catalano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline","family":"Lattmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Cipriani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4382-999X","authenticated-orcid":false,"given":"Thomas","family":"Rhomberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1764-688X","authenticated-orcid":false,"given":"Lukas","family":"Andereggen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Faculty of Medicine, University of Bern, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-6042","authenticated-orcid":false,"given":"Gerrit A.","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Department of Neurosurgery, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Bruder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"},{"name":"Department of Neurosurgery, University Hospital Frankfurt, 60629 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e0020","DOI":"10.2106\/JBJS.ST.19.00020","article-title":"Robotic-Assisted Pedicle Screw Placement During Spine Surgery","volume":"10","author":"Lieberman","year":"2020","journal-title":"JBJS Essent. 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