Mitigating radiation in robotic-assisted sacropelvic screw placement using 3D magnetic resonance imaging.

Authors

Giuseppe Loggia, Fedan Avrumova, Marco D Burkhard, Michael J Kelly, Franziska C S Altorfer, Joseph Iii C Babrowicz, Allison S Lowe, Jiaqi Zhu, Ek T Tan, Joseph L Chazen, Darren R Lebl

Published in

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

To evaluate the feasibility and accuracy of robotic-assisted (RA) sacropelvic screw placement (SPSP) using three-dimensional magnetic resonance imaging (3D MRI) for preoperative planning and robotic registration. SPSP is a critical component of spinal fixation but is subject to trajectory deviations, and radiation exposure with fluoroscopic or computed tomography (CT)-based navigation. CT-like 3D MRI-based navigation provides radiation-free preoperative imaging, but its integration with RA systems remains unexplored in SPSP.
Eight human cadavers underwent RA SPSP using MRI-based preoperative planning, including the placement of S1 pedicle screws, S1-alar-iliac (AI) screws, and S2-AI screws bilaterally. Accuracy was measured as deviation between planned vs. achieved trajectories by postoperative CT analysis. This was quantified through direct measurements and subsequently categorized using the Gertzbein-Robbins Scale (GRS).
A total of 48 screws were placed using 3D MRI-based RA navigation. Postoperative CT confirmed that 46 screws (95.8%) were graded as GRS Grade A. Among the S1 pedicle screws (n = 16), the median deviation from the planned trajectory was 0.5 mm (IQR 0.3-0.8) in the axial plane and 0.8 mm (IQR 0.5-0.9) in the sagittal plane. For S1AI and S2AI screws (n = 30), the median deviation at the entry point was 0.7 mm (IQR 0.3-1.2), while the median axial deviation from the medial SI joint border measured 0.9 mm (IQR 0.6-1.7).
This first cadaveric validation of 3D MRI-guided RA sacropelvic fixation demonstrates the feasibility of radiation-free preoperative imaging and robotic registration for precise trajectory execution.

PMID:
42593509
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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