Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.

Study Design: Clinical original research. Objectives: The objectives of this study were to identify the risk factors and incidence of anterior bone loss (ABL) after 2-level Baguera C cervical disc arthroplasty (CDA), as well as the impact of hybrid surgery on ABL. Background: ABL commonly occurs after CDA. Despite recent research on ABL, data on its incidence after 2-level CDA remain limited. Methods: In this retrospective cohort study, we reviewed patients who underwent 2-level Baguera C CDA in a medical center. We recorded the extent of ABL and radiologic parameters, including the segmental and global alignment angles, lordotic angle (or functional spinal unit angle), shell angle, global range of motion (ROM), and ROM of the index level. Results: We found that all patients had at least grade 1 ABL in 1 or 2 surgical segments. Of the 216 surgical segments analyzed, 66 (30.5%) had grade 2 ABL, 141 (65.3%) had grade 1 ABL, and only 9 (4.2%) had no bone loss at all. Patients with grade 2 ABL tended to have larger segmental and global alignment angles, and shell angle during extension than did those with grade 1 or grade 0 ABL. Conclusions: ABL is a common phenomenon found in essentially all patients receiving 2-level CDA. The extent and prevalence of ABL were greater in 2-level CDA than in 1-level CDA. Larger segmental and global alignment angles, and shell angle during extension were associated with grade 2 ABL, which is extensive bone loss with implant exposure. The exact mechanism of ABL remains to be elucidated.