Main Article Content
Techniques and technology for spinal surgery have evolved together throughout the past few decades. There has been a growing popularity of image-guided surgery that has now progressed to robotic-assisted surgery with many FDA approved image-guided surgical robot systems now widely available such as Medtronic’s Mazor X Stealth™ Edition robotic guidance system or Globus Medical’s ExcelsiusGPS® Robotic Navigation Platform. As this trend continues, it is important to understand the basis for these technologies and examine the benefits and trajectories to improve safety and effectiveness going forward. In this review we examine the history, currently available technology, and the multiple benefits that have been studied regarding image-guided navigation and robotics in spine surgery.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Jutte PC, Castelein RM. Complication of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 2002; 11(6):594-598
3. Mao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, Pollina J. Technologic evolution of navigation and robotics in spine surgery: A historical perspective. World Neurosurg 2021; 145:159-167.
4. Theodore T, Karim AA. The history of robotics in spine surgery . Spine 2018; 43:S23.
5. Kim KD, Johnson JP, Bloch O, Masciopinto JE. Computer-assisted thoracic pedicle screw placement. An in vitro feasibility study. Spine 2001; 26(4):360-364.
6. Kim KD, Johnson JP, Babbitz JD. Image-guided thoracic pedicle screw placement: a technical study in cadavers and preliminary clinical experience. Neurosurg Focus 2001; 10(2):E2.
7. Kim KD, Babbitz JD, Mimbs J. Imaging-guided costotransversectomy for thoracic disc herniation. Neurosurg Focus 2000; 9(4):E7.
8. Cadena G, Duong HT, Liu JJ, Kim KD. Atlantoaxial fixation using C1 posterior arch screws: feasibility study, morphometric data, and biomechanical analysis. J Neurosurg Spine. 2018;30(3):314-22.
9. Kim KD, Duong H, Muzumdar A, Hussain M, Moldavsky M, Bucklen B. A novel technique for sacropelvic fixation using image-guided sacroiliac screws: a case series and biomechanical study. J Biomed Res 2019; 33(3):208-216.
10. Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine 2008; 33(9):E287-292.
11. Moore T, McLain RF. Image-guided surgery in resection of benign cervicothoracic spinal tumors: a report of two cases. Spine J 2005; 5(1):109-114.
12. Kosmopoulous V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine 2007; 32(3):E111-120.
13. Nelson EM, Monazzam SM, Kim KD, Seibert JA, Klineberg EO. Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery. Spine J 2014; 14(12):2985-2991.
14. Nottmeier EW, Crosby TL. Timing of paired points and surface matching registration in three-dimensional (3D) image-guided spinal surgery. J Spinal Disord Tech. 2007; 20: 268-270.
15. Gebhard F, Weidner A, Liener UC, Stöckle U, Arand M. Navigation at the spine. Injury. 2004; 35: S-A35-45.
16. Tjardes T, Shafizadeh S, Rixen D, Paffrath T, Bouillon B, Steinhausen ES, et al. Image-guided spine surgery: state of the art and future directions. Eur Spine J. 2010; 19: 25-45.
18. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine. 2001;26(18):2049-2057.
19. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G. Complications of thoracic pedicle screws in scoliosis treatment. Spine. 2007;32((15)):1655–61.
20. Upendra BN, Meena D, Chowdhury B, Ahmad A, Jayaswal A. Outcome-based classification for assessment of thoracic pedicular screw placement. Spine. 2008;33((4)):384–90.
21. Parker SL, McGirt MJ, Farber SH, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery. 2011;68(1):170-178; discussion 178.
22. Beck M, Mittlmeier T, Gierer P, Harms C, Gradl G. Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures. Eur Spine J. 2009;18(10):1469-1477.
23. Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9(3):235-240.
24. Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine. 2007;32(2):E56-E64.
25. Mason A, Paulsen R, Babuska JM, et al. The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine. 2014;20(2):196- 203.
26. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247-255.
27. Kim H-J, Lee SH, Chang B-S, et al. Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine. 2015;40(2):87-94.
28. Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine. 2012;37(8):E496-E501.
29. Hyun SJ, Fleischhammer J, Molligaj G, et al. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions. Spine. 2017;42:353–358.
30. Gao S, Lv Z, Fang H. Robotic-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J. 2018;27:921–930.
31. Perisinakis K, Theocharopoulos N, Damilakis J, Katonis P, Papadokostakis G, Hadjipavlou A, et al: Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine (Phila Pa 1976) 29: 1555–1560, 2004
32. Abul-Kasim K, Söderberg M, Selariu E, Gunnarsson M, Kherad M, Ohlin A: Optimization of radiation exposure and image quality of the cone-beam O-arm intraoperative imaging system in spinal surgery. J Spinal Disord Tech 25:52–58, 2012
33. Nottmeier EW, Bowman C, Nelson KL: Surgeon radiation exposure in cone beam computed tomography-based, imageguided spinal surgery. Int J Med Robot 8:196–200, 2012
34. Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robot Surg. 2016;11:17–25.
35. Khanna AR, Yanamadala V, Coumans JV. Effect of intraoperative navigation on operative time in 1-level lumbar fusion surgery. J Clin Neurosci. 2016;32:72–76.
36. Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J. 2015;25:947–955.
37. Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J. 2011;20:860–868.
38. Tian W, Fan MX, Han XG, et al. Pedicle screw insertion in spine: a randomized comparison study of robot-assisted surgery and fluoroscopy-guided techniques. J Clin Orthop Res. 2016;1:4–10.
39. Tian W, Xu YF, Liu B, et al. Computer-assisted minimally invasive transforaminal lumbar interbody fusion may be better than open surgery for treating degenerative lumbar disease. Clin Spine Surg. 2017;30(6):237–242.
40. Xiao R, Miller JA, Sabharwal NC, et al. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system. J Neurosurg Spine. 2017;26(5):628–637.
41. Jiang B, Pennington Z, Azad T, et al. Robot-assisted versus freehand instrumentation in short-segment lumbar fusion: experience with real-time image-guided spinal robot. World Neurosurg. 2020;136:e635–e645.
42. Young R. The March of Robotics into the Spine Surgery: RRY Publications; 2012.
43. Fiani B, Quadri SA, Farooqui M, et al. Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: A systemic review. Neurosurg Rev. 2020;43(1):17-25.
44. Menger RP, Savardekar AR, Farokhi F, Sin A. A Cost-Effectiveness Analysis of the Integration of Robotic Spine Technology in Spine Surgery. Neurospine. 2018;15(3):216-24.
45. Sommer F, Goldberg JL, McGrath Jr L, Kirnaz S, Medary B, Hartl R. Image guidance in spinal surgery: a critical appraisal and future directions. Int J Spine Surg 2021; 15(Supple2): S74-S86