Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Heeren S. Makanji, MD; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Nicolas Dea, MD, MSc, FRCSC; John Chi, MD, MPH; Peter G. Whang, MD, FACS


Spine. 2021;46(4):E277-E285. 

In This Article

Abstract and Introduction


Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine. 2019 Feb 8:1–8. [Epub ahead of print]

Posterior instrumentation is routinely placed during spinal fusion operations to confer greater segmental stability with the goals being to enhance arthrodesis rates and facilitate deformity reduction. However, malpositioned implants are associated with a number of significant complications including neurovascular injury or suboptimal fixation with an increased risk of pseudarthrosis. In addition to referencing anatomic landmarks and direct palpation of screw tracts, surgeons may employ various other strategies to improve the accuracy of lumbar transpedicular instrumentation including neuromonitoring, intraoperative imaging, and navigation. Robotic systems have been employed extensively in other surgical subspecialties and more recently have been utilized for spinal applications as well. Specifically, robotic devices may have the potential to improve procedural workflow and perform tasks with greater precision, including the insertion of pedicle screws. However, given that these robotic platforms require a considerable capital investment, it is imperative that there be sufficient high-quality evidence to justify their cost as well as the inherent learning curve surgeons must overcome as they adopt this technology. To this end, Han et al[1] published the results of a prospective randomized controlled trial comparing the safety and accuracy of thoracolumbar pedicle screws introduced with either conventional fluoroscopy or with the assistance of a robotic system.