Clinical outcomes and complications of robotic-assisted spine surgery: using the ExcelsiusGPS system: a single-surgeon case series

Robotic spine surgery with the ExcelsiusGPS system aims to enhance pedicle screw accuracy and reduce complications, though outcome data remain limited. This study evaluates the safety, accuracy, and clinical utility of the ExcelsiusGPS platform in a single-surgeon series, focusing on screw precision, symptom improvement, complication rates, and workflow integration. A retrospective review was performed on 85 consecutive ExcelsiusGPS-assisted spine surgeries performed between January 2022 and December 2024. 56 patients met inclusion criteria with ≥ 90 days of follow-up. Data included demographics, surgical details, outcomes, and imaging. Primary endpoints were screw accuracy, symptom improvement, and operative time. Secondary endpoints included complication rates, revisions, and readmissions. Accuracy was assessed intraoperatively using O-arm imaging and Gertzbein-Robbins grading. Wilcoxon signed-rank tests evaluated symptom changes (p < .05). Clopper-Pearson exact methods was utilized to calculate 95% confidence intervals. 56 cases involving 517 screws were analyzed. Mean age was 62.2 years; average fusion involved 4.7 levels and 9.2 screws per case. Half were percutaneous, and 16% were revision surgeries. No intraoperative screw complications occurred. The 90-day revision rate was 0%. 30 day complications occurred in 7.2% of cases, including three surgical site infections and one wound dehiscence. Two patients (3.6%) were readmitted. Significant postoperative improvements were observed in leg and back pain (p < .01), weakness (p < .01), gait (p < .01), constipation (p < .46), and urinary symptoms (p < .01). Three navigation errors occurred, including one robot abort due to severe scoliosis. One-year proximal junctional kyphosis rate was 5.6%. The ExcelsiusGPS system appears safe and effective for robotic-assisted spine surgery, with high pedicle screw accuracy and low complication and revision rates. These findings support its clinical non-inferiority to conventional methods and highlight opportunities for future research in complex deformities and cost-effectiveness.