Effect of surgeon expertise on the accuracy and time required for fluoroscopic, navigated, and robot-assisted thoracolumbar pedicle screw placement

Technological advances in minimally invasive pedicle screw (PS) placement have progressed from 2D fluoroscopy (FL) to 3D navigation (NAV) and robot-assisted navigation (RA). Whether increasing technical support can compensate for limited surgical experience remains unclear. This study investigated the influence of surgeon experience and guidance technology on PS insertion time and accuracy during first-time use. In this experimental study, nine artificial thoracolumbar spine models (T7–S1) were instrumented. Three surgeons with varying levels of experience each placed 72 PS using FL, NAV, and RA. Screw accuracy was assessed using cone-beam CT and classified according to the Gertzbein–Robbins grading system. Median insertion times differed significantly between techniques (p