Comprehensive Outcomes Following Navigated Robotics in Thoracolumbar Spine Surgery: The PRoGRSS Final Analysis

Abstract

Study DesignProspective multicenter cohort study.ObjectivesIntegration of robotic guidance with navigation represents a natural evolution in spine surgery technologies. Both modalities have independently demonstrated improved implant accuracy, reduced radiation exposure, and expanded minimally invasive capabilities, yet data on integrated platforms remain limited. The Prospective Robotic-Guided Registry of Spine Surgery (PRoGRSS) evaluates surgical, clinical, and patient-reported outcomes across a broad range of procedures performed with an integrated robotic-assisted navigation system.MethodsAdults undergoing navigated robotic thoracolumbar surgery between 2020 and 2024 were enrolled by six surgeons across four centers. Demographic, surgical, and robot-related metrics were collected. Patient-reported outcomes included ODI and PROMIS Global Health, Physical Function, and Pain Interference. Complications, revision surgery, inpatient resource utilization, and return-to-work metrics were analyzed.ResultsOf 657 enrolled patients, 606 completed 12-month follow-up (92%). Median age was 60 years; 49.9% were female. Of 5166 planned screws, 99.2% were placed, with 98.4% accurately positioned and 1.5% malpositioned. Robot abandonment occurred in 0.6% of cases. Robot-related intraoperative or postoperative adverse events occurred in 0.3% of cases. Twelve-month revision surgery rate was 4.8%, including 0.3% robot-related revisions. Resource utilization was low: 5.2% required transfusion, 2.1% postoperative CT, median length of stay was 3 days, and 88.4% were discharged home. Patients demonstrated significant, clinically meaningful improvement across all PRO domains.ConclusionsThis large prospective evaluation of an integrated navigation-robotic platform demonstrates high accuracy, low complication and revision rates, efficient resource use, and substantial patient-reported outcome improvement, establishing a contemporary benchmark for navigated robotic spine surgery.