Robotic assisted spinopelvic fixation for complex pelvic and spinopelvic fractures: our experience and surgical technique

Complex pelvic and spinopelvic injuries present significant surgical challenges, often requiring intricate reduction and stabilization. Minimally invasive techniques reduce soft-tissue complications but are technically demanding. This study evaluates the safety, feasibility, and outcomes of using robotic-assisted navigation for spinopelvic fixation in complex trauma and presents our workflow and technique for these cases. A retrospective review was conducted of patients who underwent robotic-assisted spinopelvic fixation for traumatic pelvic and spinopelvic injuries at a single tertiary center. Outcome measures included reduction adequacy, operative time, radiation exposure, hardware failure, and postoperative complications. Sixteen patients (81% male; mean age 39 years) with AOSpine type B/C sacral fractures or AOTrauma type C pelvic fractures were included; 38% had neurological deficits. Closed reduction was successful in 15 patients. All received spinopelvic fixation, with additional sacroiliac fixation in 15 cases. Median follow-up was 18 months (minimum 3 months; 3 lost to follow-up due to international relocation and excluded from long-term follow up). Mean operative time was 218 min (range 60–350). Intraoperative radiation exposure involved a median of 27 fluoroscopy shots (range 2–149) and 1 3D spin (range 0–3). Postoperative complications included one unilateral spinopelvic hardware failure and one sacroiliac screw failure; neither required revision surgery. No wound infections or dehiscence requiring intervention occurred. Robotic-assisted navigation offers a safe, feasible, and reproducible workflow for percutaneous stabilization of complex spinopelvic trauma in this descriptive cohort. It successfully integrates into multidisciplinary trauma-spine workflows, demonstrating the feasibility of precise instrumentation while preserving the soft-tissue benefits of minimally invasive surgery. Given the absence of a control group, these findings represent an initial descriptive feasibility series further studies to assess clinical superiority are needed.