Introduction: Robot-assisted spine surgeries have gained traction in recent years, offering the advantage of minimally invasive techniques which not only improve precision in preoperative planning and intraoperative execution, while reducing bone cement leakage and minimizing radiation exposure to both patients and operating staff but also result in better pain relief and faster return to function for patients.

Methods: We present a case series of 2 patients who had undergone robot-guided percutaneous balloon kyphoplasty (rPBK). Both patients had sustained fragility fractures. Case 1 is a 77-year-old female who fell from standing height and sustained a severe T12 burst fracture with intact neurology in bilateral lower limbs. She also had multiple previous lumbar spine surgeries cumulating in an L2-S1 decompression, fusion and instrumentation in 2022. We had utilized the Mazor X robotic guidance system to aid with a minimally invasive segment rPBK. Case 2 is a 75-year-old female with a background of system lupus erythematosus, and osteoporosis who sustained a T11 burst fracture with severe vertebral collapse and bilateral lower limb radicular pain with L2 bilateral grade 4 power. Similarly, she had a rPBK done. The robotic workflow involves utilizing a pre-operative computer tomography (CT) scan for planning which is integrated into the Mazor robot to allow for more accurate pre-set trajectories for pedicle entries for injection of deployment of the balloons and subsequent cementing whilst minimizing the risks of complications.

Results: Both patients reported significant pain reduction post-operatively and were allowed for weight bearing with spinal orthoses post operatively. Patient 1 was able to ambulate 40m without aid post operation and was discharge the next day. Patient 2 reported marked improvement in her radicular pain and ambulated 10m post-operation day 1.

Conclusion: Robotic-guided kyphoplasty offers a viable, minimally invasive, and safe option for patients with severely collapsed fractures where the margin for error is small. This allows for precise pre- operative planning with CT scans and only requires intraoperative confirmatory image intensifier shots. The greater precision also allows more accurate delivery of bone cement and reduces the chance of cement leakage or endplate injury.