{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:24:01Z","timestamp":1783488241692,"version":"3.55.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Robot-assisted pedicle screw placement in spinal fusion has been well studied. However, few studies have evaluated robot-assisted sacroiliac joint (SIJ) fusion. The aim of this study was to compare surgical characteristics, accuracy, and complications between robot-assisted and fluoroscopically guided SIJ fusion.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective review of 110 patients with 121 SIJ fusions done at a single academic institution was conducted from 2014 to 2023. Inclusion criteria included adult age and a robot- or fluoroscopically guided approach to SIJ fusion. Patients were excluded if the SIJ fusion was part of a longer fusion construct, not minimally invasive, and\/or had missing data. Demographics, approach type (robotic vs fluoroscopic), operative time, estimated blood loss (EBL), number of screws, intraoperative complications, 30-day complications, number of intraoperative fluoroscopic images (as a surrogate for radiation exposure), implant placement accuracy, and pain status at the first follow-up were recorded. Primary endpoints were SIJ screw placement accuracy and complications. Secondary endpoints were operative time, radiation exposure, and pain status at the first follow-up.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Ninety patients were included who underwent a total of 101 SIJ fusions, of which 78 were robotic and 23 were fluoroscopic. The mean age of the cohort at the time of surgery was 55.9 \u00b1 13.8 years; 46 patients were females (51.1%). No difference was found in screw placement accuracy between robotic and fluoroscopic fusion (1.3% vs 8.7%, p = 0.06). Chi-square analysis of robotic versus fluoroscopic fusion found no difference in the presence of 30-day complications (p = 0.62). Mann-Whitney U-test analysis found that robotic fusion had a significantly longer operative time than fluoroscopic fusion (72.0 vs 61.0 minutes, p = 0.01); however, robot-assisted fusions involved significantly lower radiation exposure (26.7 vs 187.4 fluoroscopic images, p < 0.001). No difference in EBL was noted (p = 0.17). No intraoperative complications were present in this cohort. Subgroup analysis comparing the 23 most recent robotic cases against the 23 fluoroscopic cases found that robotic fusion still was associated with significantly longer operative times than fluoroscopic fusion (74.0 \u00b1 26.4 vs 61.0 \u00b1 14.9 minutes, respectively; p = 0.047).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n SIJ screw placement accuracy did not significantly differ between robot-assisted and fluoroscopic SIJ fusion. Complications overall were low and similar between the two groups. The operative time was longer with robotic assistance, but there was markedly less radiation exposure to the surgeon and staff.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.4.focus23146","type":"journal-article","created":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T08:55:05Z","timestamp":1688201705000},"page":"E4","source":"Crossref","is-referenced-by-count":5,"title":["Robotic versus nonrobotic sacroiliac joint fusion"],"prefix":"10.3171","volume":"55","author":[{"given":"John H.","family":"Lee","sequence":"first","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark M.","family":"Zaki","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushikesh S.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Linzey","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh D.","family":"Patel","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes-Murphey Clinic, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamaan S.","family":"Saadeh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Fed Pract","first-page":"370","article-title":"Sacroiliac joint dysfunction in patients with low back pain","volume":"36","author":"Barros G","year":"2019","unstructured":"Barros G, McGrath L, Gelfenbeyn M. Sacroiliac joint dysfunction in patients with low back pain. Fed Pract. 2019;36(8):370\u2013375."},{"issue":"3","key":"b2","series-title":"J Manual Manip Ther","first-page":"142","article-title":"Evidence-based diagnosis and treatment of the painful sacroiliac joint","volume":"16","author":"Laslett M","year":"2008","unstructured":"Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Manual Manip Ther. 2008;16(3):142\u2013152."},{"issue":"1","key":"b3","series-title":"Expert Rev Neurother","first-page":"99","article-title":"Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment","volume":"13","author":"Cohen SP","year":"2013","unstructured":"Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99\u2013116."},{"issue":"3","key":"b4","series-title":"J Am Acad Orthop Surg","first-page":"85","article-title":"Diagnosing sacroiliac joint pain","volume":"27","author":"Thawrani DP","year":"2019","unstructured":"Thawrani DP, Agabegi SS, Asghar F. Diagnosing sacroiliac joint pain. J Am Acad Orthop Surg. 2019;27(3):85\u201393."},{"issue":"23","key":"b5","series-title":"J Bone Joint Surg Am","first-page":"2027","article-title":"Diagnosis and management of sacroiliac joint dysfunction","volume":"99","author":"Ou-Yang DC","year":"2017","unstructured":"Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and management of sacroiliac joint dysfunction. J Bone Joint Surg Am. 2017;99(23):2027\u20132036."},{"key":"b6","series-title":"J Pain Res","first-page":"3135","article-title":"Successful diagnosis of sacroiliac joint dysfunction","volume":"14","author":"Buchanan P","year":"2021","unstructured":"Buchanan P, Vodapally S, Lee DW, Successful diagnosis of sacroiliac joint dysfunction. J Pain Res. 2021;14:3135\u20133143."},{"issue":"382","key":"b7","series-title":"Clin Orthop Relat Res","first-page":"112","article-title":"Computed tomography findings in patients with sacroiliac pain","author":"Elgafy H","year":"2001","unstructured":"Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ. Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res. 2001;(382):112-118."},{"issue":"2","key":"b8","series-title":"Quant Imaging Med Surg","first-page":"318","article-title":"Imaging of sacroiliitis: current status, limitations and pitfalls","volume":"9","author":"Tsoi C","year":"2019","unstructured":"Tsoi C, Griffith JF, Lee RKL, Wong PCH, Tam LS. Imaging of sacroiliitis: current status, limitations and pitfalls. Quant Imaging Med Surg. 2019;9(2):318\u2013335."},{"key":"b9","series-title":"J Pain Res","first-page":"3337","article-title":"A review and algorithm in the diagnosis and treatment of sacroiliac joint pain","volume":"13","author":"Falowski S","year":"2020","unstructured":"Falowski S, Sayed D, Pope J, A review and algorithm in the diagnosis and treatment of sacroiliac joint pain. J Pain Res. 2020;13:3337\u20133348."},{"issue":"suppl 1","key":"b10","series-title":"PM R","first-page":"S114","article-title":"Sacroiliac joint fusion: approaches and recent outcomes","volume":"11","author":"Yson SC","year":"2019","unstructured":"Yson SC, Sembrano JN, Polly DW Jr. Sacroiliac joint fusion: approaches and recent outcomes. PM R. 2019;11(suppl 1):S114-S117."},{"issue":"8","key":"b11","series-title":"Spine J","first-page":"1240","article-title":"Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review","volume":"22","author":"Chang E","year":"2022","unstructured":"Chang E, Rains C, Ali R, Wines RC, Kahwati LC. Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review. Spine J. 2022;22(8):1240\u20131253."},{"key":"b12","series-title":"Open Orthop J","first-page":"7","article-title":"Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system","volume":"12","author":"Cross WW","year":"2018","unstructured":"Cross WW, Delbridge A, Hales D, Fielding LC. Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system. Open Orthop J. 2018;12:7\u201316."},{"issue":"1","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e54","article-title":"Robot-assisted minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: 2-dimensional operative video","volume":"23","author":"Holste KG","year":"2022","unstructured":"Holste KG, Saleh S, Bruzek AK, Strong MJ, Park P. Robot-assisted minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2022;23(1):e54."},{"issue":"20","key":"b14","series-title":"Spine (Phila Pa 1976).","first-page":"2637","article-title":"Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion","volume":"25","author":"Rampersaud YR","year":"2000","unstructured":"Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976).2000;25(20):2637\u20132645."},{"issue":"12","key":"b15","series-title":"Spine J","first-page":"2985","article-title":"Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery","volume":"14","author":"Nelson EM","year":"2014","unstructured":"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\u20132991."},{"issue":"6","key":"b16","series-title":"World Neurosurg","first-page":"1337","article-title":"Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure","volume":"82","author":"Srinivasan D","year":"2014","unstructured":"Srinivasan D, Than KD, Wang AC, Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014;82(6):1337\u20131343."},{"issue":"3","key":"b17","series-title":"Spine J","first-page":"343","article-title":"Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation","volume":"16","author":"Mendelsohn D","year":"2016","unstructured":"Mendelsohn D, Strelzow J, Dea N, Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J. 2016;16(3):343\u2013354."},{"key":"b18","series-title":"World Neurosurg","first-page":"353","article-title":"Hazards of ionizing radiation and its impact on spine surgery","volume":"92","author":"Hadelsberg UP","year":"2016","unstructured":"Hadelsberg UP, Harel R. Hazards of ionizing radiation and its impact on spine surgery. World Neurosurg. 2016;92:353\u2013359."},{"key":"b19","series-title":"N Am Spine Soc J","first-page":"100199","article-title":"Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; a systematic review","volume":"13","author":"Caelers IJMH","year":"2023","unstructured":"Caelers IJMH, Berendsen RCM, Droeghaag R, Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; a systematic review. N Am Spine Soc J. 2023;13:100199."},{"issue":"2","key":"b20","series-title":"Eur J Nucl Med","first-page":"77","article-title":"Recommendations of the International Commission on Radiological Protection (ICRP) 1990","volume":"19","author":"Mountford PJ","year":"1992","unstructured":"Mountford PJ, Temperton DH. Recommendations of the International Commission on Radiological Protection (ICRP) 1990. Eur J Nucl Med. 1992;19(2):77\u201379."},{"issue":"4","key":"b21","series-title":"J Spinal Disord Tech","first-page":"264","article-title":"Radiation exposure to the surgeon during percutaneous pedicle screw placement","volume":"24","author":"Mroz TE","year":"2011","unstructured":"Mroz TE, Abdullah KG, Steinmetz MP, Klineberg EO, Lieberman IH. Radiation exposure to the surgeon during percutaneous pedicle screw placement. J Spinal Disord Tech. 2011;24(4):264\u2013267."},{"issue":"8","key":"b1","series-title":"Fed Pract","first-page":"370","article-title":"Sacroiliac joint dysfunction in patients with low back pain","volume":"36","author":"Barros G","year":"2019","unstructured":"Barros G, McGrath L, Gelfenbeyn M. Sacroiliac joint dysfunction in patients with low back pain. Fed Pract. 2019;36(8):370\u2013375."},{"issue":"3","key":"b2","series-title":"J Manual Manip Ther","first-page":"142","article-title":"Evidence-based diagnosis and treatment of the painful sacroiliac joint","volume":"16","author":"Laslett M","year":"2008","unstructured":"Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Manual Manip Ther. 2008;16(3):142\u2013152."},{"issue":"1","key":"b3","series-title":"Expert Rev Neurother","first-page":"99","article-title":"Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment","volume":"13","author":"Cohen SP","year":"2013","unstructured":"Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99\u2013116."},{"issue":"3","key":"b4","series-title":"J Am Acad Orthop Surg","first-page":"85","article-title":"Diagnosing sacroiliac joint pain","volume":"27","author":"Thawrani DP","year":"2019","unstructured":"Thawrani DP, Agabegi SS, Asghar F. Diagnosing sacroiliac joint pain. J Am Acad Orthop Surg. 2019;27(3):85\u201393."},{"issue":"23","key":"b5","series-title":"J Bone Joint Surg Am","first-page":"2027","article-title":"Diagnosis and management of sacroiliac joint dysfunction","volume":"99","author":"Ou-Yang DC","year":"2017","unstructured":"Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and management of sacroiliac joint dysfunction. J Bone Joint Surg Am. 2017;99(23):2027\u20132036."},{"key":"b6","series-title":"J Pain Res","first-page":"3135","article-title":"Successful diagnosis of sacroiliac joint dysfunction","volume":"14","author":"Buchanan P","year":"2021","unstructured":"Buchanan P, Vodapally S, Lee DW, Successful diagnosis of sacroiliac joint dysfunction. J Pain Res. 2021;14:3135\u20133143."},{"issue":"382","key":"b7","series-title":"Clin Orthop Relat Res","first-page":"112","article-title":"Computed tomography findings in patients with sacroiliac pain","author":"Elgafy H","year":"2001","unstructured":"Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ. Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res. 2001;(382):112-118."},{"issue":"2","key":"b8","series-title":"Quant Imaging Med Surg","first-page":"318","article-title":"Imaging of sacroiliitis: current status, limitations and pitfalls","volume":"9","author":"Tsoi C","year":"2019","unstructured":"Tsoi C, Griffith JF, Lee RKL, Wong PCH, Tam LS. Imaging of sacroiliitis: current status, limitations and pitfalls. Quant Imaging Med Surg. 2019;9(2):318\u2013335."},{"key":"b9","series-title":"J Pain Res","first-page":"3337","article-title":"A review and algorithm in the diagnosis and treatment of sacroiliac joint pain","volume":"13","author":"Falowski S","year":"2020","unstructured":"Falowski S, Sayed D, Pope J, A review and algorithm in the diagnosis and treatment of sacroiliac joint pain. J Pain Res. 2020;13:3337\u20133348."},{"issue":"suppl 1","key":"b10","series-title":"PM R","first-page":"S114","article-title":"Sacroiliac joint fusion: approaches and recent outcomes","volume":"11","author":"Yson SC","year":"2019","unstructured":"Yson SC, Sembrano JN, Polly DW Jr. Sacroiliac joint fusion: approaches and recent outcomes. PM R. 2019;11(suppl 1):S114-S117."},{"issue":"8","key":"b11","series-title":"Spine J","first-page":"1240","article-title":"Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review","volume":"22","author":"Chang E","year":"2022","unstructured":"Chang E, Rains C, Ali R, Wines RC, Kahwati LC. Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review. Spine J. 2022;22(8):1240\u20131253."},{"key":"b12","series-title":"Open Orthop J","first-page":"7","article-title":"Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system","volume":"12","author":"Cross WW","year":"2018","unstructured":"Cross WW, Delbridge A, Hales D, Fielding LC. Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system. Open Orthop J. 2018;12:7\u201316."},{"issue":"1","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e54","article-title":"Robot-assisted minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: 2-dimensional operative video","volume":"23","author":"Holste KG","year":"2022","unstructured":"Holste KG, Saleh S, Bruzek AK, Strong MJ, Park P. Robot-assisted minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2022;23(1):e54."},{"issue":"20","key":"b14","series-title":"Spine (Phila Pa 1976).","first-page":"2637","article-title":"Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion","volume":"25","author":"Rampersaud YR","year":"2000","unstructured":"Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976).2000;25(20):2637\u20132645."},{"issue":"12","key":"b15","series-title":"Spine J","first-page":"2985","article-title":"Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery","volume":"14","author":"Nelson EM","year":"2014","unstructured":"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\u20132991."},{"issue":"6","key":"b16","series-title":"World Neurosurg","first-page":"1337","article-title":"Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure","volume":"82","author":"Srinivasan D","year":"2014","unstructured":"Srinivasan D, Than KD, Wang AC, Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014;82(6):1337\u20131343."},{"issue":"3","key":"b17","series-title":"Spine J","first-page":"343","article-title":"Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation","volume":"16","author":"Mendelsohn D","year":"2016","unstructured":"Mendelsohn D, Strelzow J, Dea N, Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J. 2016;16(3):343\u2013354."},{"key":"b18","series-title":"World Neurosurg","first-page":"353","article-title":"Hazards of ionizing radiation and its impact on spine surgery","volume":"92","author":"Hadelsberg UP","year":"2016","unstructured":"Hadelsberg UP, Harel R. Hazards of ionizing radiation and its impact on spine surgery. World Neurosurg. 2016;92:353\u2013359."},{"key":"b19","series-title":"N Am Spine Soc J","first-page":"100199","article-title":"Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; a systematic review","volume":"13","author":"Caelers IJMH","year":"2023","unstructured":"Caelers IJMH, Berendsen RCM, Droeghaag R, Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; a systematic review. N Am Spine Soc J. 2023;13:100199."},{"issue":"2","key":"b20","series-title":"Eur J Nucl Med","first-page":"77","article-title":"Recommendations of the International Commission on Radiological Protection (ICRP) 1990","volume":"19","author":"Mountford PJ","year":"1992","unstructured":"Mountford PJ, Temperton DH. Recommendations of the International Commission on Radiological Protection (ICRP) 1990. Eur J Nucl Med. 1992;19(2):77\u201379."},{"issue":"4","key":"b21","series-title":"J Spinal Disord Tech","first-page":"264","article-title":"Radiation exposure to the surgeon during percutaneous pedicle screw placement","volume":"24","author":"Mroz TE","year":"2011","unstructured":"Mroz TE, Abdullah KG, Steinmetz MP, Klineberg EO, Lieberman IH. Radiation exposure to the surgeon during percutaneous pedicle screw placement. 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