{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:55:41Z","timestamp":1792900541176,"version":"4.5.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>As robot systems for spine surgery have been developed, they have demonstrated a high degree of accuracy in screw placement without sacrificing safety or surgical efficiency. These robotic systems offer preoperative planning and real-time feedback to enhance surgical precision and mitigate human error. Nevertheless, limitations to their optimal performance remain. The authors analyzed the initial 100 cases of pedicle screw placements performed using the Mazor X robot at their institution, presenting case examples to illustrate the limitations that were experienced, and reviewed current literature on the limitations of robot-assisted spine surgery, emphasizing their impact on accuracy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This was a retrospective review of the first 100 cases of robot-assisted pedicle screw placement at the authors\u2019 institution between December 2019 and June 2024. All intraoperative CT scans were reviewed for screw accuracy. Malpositioned screws, near misses (screw deviation without injury to the patient), or abandoned robot-assisted attempts were identified, and the underlying reasons were evaluated to determine the limitations of current robot technology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of the first 100 cases of robot-assisted pedicle screw placement, there were 20 screw-related complications, of which 14 were near misses, 1 involved neurological injury caused by screw malposition, and 5 were cases in which a robot-assisted attempt was abandoned before manual screw placement. The authors identified the following limitations with current robot technology: registration errors, spine movement after registration, patient body habitus, artifact from metallic implants, poor bone differentiation, skiving, soft-tissue interference, and physical constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Despite the advancements of spine robot systems, several limitations persist, especially in mobile or unstable spine locations and around critical structures. The authors\u2019 experience, with provided case examples, further illustrates technical nuances important to understanding and navigating around these limitations. The need for standardized reporting metrics to evaluate and classify emerging technologies is highlighted, emphasizing ongoing technological innovation to enhance the efficacy of robot-assisted spine surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.focus24545","type":"journal-article","created":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T08:24:53Z","timestamp":1733041493000},"page":"E14","source":"Crossref","is-referenced-by-count":16,"title":["Limitations of current robot-assisted pedicle screw insertion systems"],"prefix":"10.3171","volume":"57","author":[{"given":"Caitlyn","family":"Wandvik","sequence":"first","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline E.","family":"Greil","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Colby","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diwas","family":"Gautam","sequence":"additional","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus D.","family":"Mazur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Spine Surg","first-page":"305","article-title":"Robotic-assisted spine surgery\u2014a narrative review","volume":"10","author":"Antonacci CL","year":"2024","unstructured":"Antonacci CL, Zeng F, Block A, Davey A, Makanji H. Robotic-assisted spine surgery\u2014a narrative review. J Spine Surg. 2024;10(2):305\u2013312."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"519","article-title":"Comparison of accuracy, revision, and perioperative outcomes in robot-assisted spine surgeries: systematic review and meta-analysis","volume":"41","author":"MacLean L","year":"2024","unstructured":"MacLean L, Hersh AM, Bhimreddy M,  Comparison of accuracy, revision, and perioperative outcomes in robot-assisted spine surgeries: systematic review and meta-analysis. J Neurosurg Spine. 2024;41(4):519\u2013531."},{"issue":"3","key":"b3","series-title":"HSS J","first-page":"308","article-title":"Overview of robotic technology in spine surgery","volume":"17","author":"Alluri RK","year":"2021","unstructured":"Alluri RK, Avrumova F, Sivaganesan A, Vaishnav AS, Lebl DR, Qureshi SA. Overview of robotic technology in spine surgery. HSS J. 2021;17(3):308\u2013316."},{"key":"b4","series-title":"J Orthop","first-page":"49","article-title":"Flattening the learning curve\u2013early experience of robotic-assisted pedicle screw placement in spine surgery","volume":"57","author":"Srinivasa V","year":"2024","unstructured":"Srinivasa V, Thirugnanam B, Pai Kanhangad M,  Flattening the learning curve\u2013early experience of robotic-assisted pedicle screw placement in spine surgery. J Orthop. 2024;57:49\u201354."},{"issue":"1","key":"b5","series-title":"Eur J Orthop Surg Traumatol","first-page":"127","article-title":"Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy","volume":"34","author":"Akazawa T","year":"2024","unstructured":"Akazawa T, Torii Y, Ueno J,  Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy. 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Eur Spine J. 2013;22(3):661\u2013666."},{"issue":"4","key":"b18","series-title":"Int J Med Robot","first-page":"e2273","article-title":"Accuracy and deviation analysis of robot-assisted spinal implants: a retrospective overview of 105 cases and preliminary comparison to open freehand surgery in lumbar spondylolisthesis","volume":"17","author":"Wang C","year":"2021","unstructured":"Wang C, Zhang H, Zhang L,  Accuracy and deviation analysis of robot-assisted spinal implants: a retrospective overview of 105 cases and preliminary comparison to open freehand surgery in lumbar spondylolisthesis. Int J Med Robot. 2021;17(4):e2273."},{"issue":"5","key":"b19","series-title":"Global Spine J","first-page":"512","article-title":"Intraoperative error propagation in 3-dimensional spinal navigation from nonsegmental registration: a prospective cadaveric and clinical study","volume":"9","author":"Guha D","year":"2019","unstructured":"Guha D, Jakubovic R, Gupta S,  Intraoperative error propagation in 3-dimensional spinal navigation from nonsegmental registration: a prospective cadaveric and clinical study. Global Spine J. 2019;9(5):512\u2013520."},{"issue":"2","key":"b20","series-title":"J Spine Surg","first-page":"141","article-title":"Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes","volume":"7","author":"Avrumova F","year":"2021","unstructured":"Avrumova F, Morse KW, Heath M, Widmann RF, Lebl DR. 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J Spine Surg. 2024;10(2):305\u2013312."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"519","article-title":"Comparison of accuracy, revision, and perioperative outcomes in robot-assisted spine surgeries: systematic review and meta-analysis","volume":"41","author":"MacLean L","year":"2024","unstructured":"MacLean L, Hersh AM, Bhimreddy M,  Comparison of accuracy, revision, and perioperative outcomes in robot-assisted spine surgeries: systematic review and meta-analysis. J Neurosurg Spine. 2024;41(4):519\u2013531."},{"issue":"3","key":"b3","series-title":"HSS J","first-page":"308","article-title":"Overview of robotic technology in spine surgery","volume":"17","author":"Alluri RK","year":"2021","unstructured":"Alluri RK, Avrumova F, Sivaganesan A, Vaishnav AS, Lebl DR, Qureshi SA. Overview of robotic technology in spine surgery. HSS J. 2021;17(3):308\u2013316."},{"key":"b4","series-title":"J Orthop","first-page":"49","article-title":"Flattening the learning curve\u2013early experience of robotic-assisted pedicle screw placement in spine surgery","volume":"57","author":"Srinivasa V","year":"2024","unstructured":"Srinivasa V, Thirugnanam B, Pai Kanhangad M,  Flattening the learning curve\u2013early experience of robotic-assisted pedicle screw placement in spine surgery. J Orthop. 2024;57:49\u201354."},{"issue":"1","key":"b5","series-title":"Eur J Orthop Surg Traumatol","first-page":"127","article-title":"Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy","volume":"34","author":"Akazawa T","year":"2024","unstructured":"Akazawa T, Torii Y, Ueno J,  Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy. Eur J Orthop Surg Traumatol. 2024;34(1):127\u2013134."},{"issue":"7","key":"b6","series-title":"J Pediatr Orthop","first-page":"e524","article-title":"Comprehensive error analysis for robotic-assisted placement of pedicle screws in pediatric spinal deformity: the initial learning curve","volume":"41","author":"Morse KW","year":"2021","unstructured":"Morse KW, Heath M, Avrumova F,  Comprehensive error analysis for robotic-assisted placement of pedicle screws in pediatric spinal deformity: the initial learning curve. J Pediatr Orthop. 2021;41(7):e524\u2013e532."},{"issue":"5","key":"b7","series-title":"Bone Joint J","first-page":"543","article-title":"Robotic-navigated assistance in spine surgery","volume":"105-B","author":"Abel F","year":"2023","unstructured":"Abel F, Avrumova F, Goldman SN,  Robotic-navigated assistance in spine surgery. Bone Joint J. 2023;105-B(5):543-550."},{"issue":"3S)(3s","key":"b8","series-title":"Neurosurgery","first-page":"S86","article-title":"Navigation and robotics in spinal surgery: where are we now","volume":"80","author":"Overley SC","year":"2017","unstructured":"Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: where are we now? Neurosurgery. 2017;80(3S)(3s):S86\u2013S99."},{"issue":"1","key":"b9","series-title":"J Robot Surg","first-page":"177","article-title":"Ensuring navigation integrity using robotics in spine surgery","volume":"14","author":"Crawford N","year":"2020","unstructured":"Crawford N, Johnson N, Theodore N. Ensuring navigation integrity using robotics in spine surgery. J Robot Surg. 2020;14(1):177\u2013183."},{"issue":"23","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"1661","article-title":"Complications and revision rates in minimally invasive robotic-guided versus fluoroscopic-guided spinal fusions: the MIS ReFRESH prospective comparative study","volume":"46","author":"Good CR","year":"2021","unstructured":"Good CR, Orosz L, Schroerlucke SR,  Complications and revision rates in minimally invasive robotic-guided versus fluoroscopic-guided spinal fusions: the MIS ReFRESH prospective comparative study. Spine (Phila Pa 1976). 2021;46(23):1661\u20131668."},{"issue":"1","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"11","article-title":"Accuracy of pedicular screw placement in vivo","volume":"15","author":"Gertzbein SD","year":"1990","unstructured":"Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. 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Neurosurgery. 2013;72(Suppl 1):12\u201318."},{"issue":"3","key":"b16","series-title":"Medicine (Baltimore)","first-page":"e5835","article-title":"Pedicle screw placement accuracy of bone-mounted miniature robot system","volume":"96","author":"Tsai TH","year":"2017","unstructured":"Tsai TH, Tzou RD, Su YF, Wu CH, Tsai CY, Lin CL. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine (Baltimore). 2017;96(3):e5835."},{"issue":"3","key":"b17","series-title":"Eur Spine J","first-page":"661","article-title":"Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients","volume":"22","author":"Hu X","year":"2013","unstructured":"Hu X, Ohnmeiss DD, Lieberman IH. Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients. Eur Spine J. 2013;22(3):661\u2013666."},{"issue":"4","key":"b18","series-title":"Int J Med Robot","first-page":"e2273","article-title":"Accuracy and deviation analysis of robot-assisted spinal implants: a retrospective overview of 105 cases and preliminary comparison to open freehand surgery in lumbar spondylolisthesis","volume":"17","author":"Wang C","year":"2021","unstructured":"Wang C, Zhang H, Zhang L,  Accuracy and deviation analysis of robot-assisted spinal implants: a retrospective overview of 105 cases and preliminary comparison to open freehand surgery in lumbar spondylolisthesis. Int J Med Robot. 2021;17(4):e2273."},{"issue":"5","key":"b19","series-title":"Global Spine J","first-page":"512","article-title":"Intraoperative error propagation in 3-dimensional spinal navigation from nonsegmental registration: a prospective cadaveric and clinical study","volume":"9","author":"Guha D","year":"2019","unstructured":"Guha D, Jakubovic R, Gupta S,  Intraoperative error propagation in 3-dimensional spinal navigation from nonsegmental registration: a prospective cadaveric and clinical study. Global Spine J. 2019;9(5):512\u2013520."},{"issue":"2","key":"b20","series-title":"J Spine Surg","first-page":"141","article-title":"Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes","volume":"7","author":"Avrumova F","year":"2021","unstructured":"Avrumova F, Morse KW, Heath M, Widmann RF, Lebl DR. 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Spine (Phila Pa 1976). 2022;47(23):1613\u20131619."},{"issue":"5","key":"b22","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws","volume":"42","author":"Keric N","year":"2017","unstructured":"Keric N, Doenitz C, Haj A,  Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus. 2017;42(5):E11."},{"issue":"24","key":"b23","series-title":"Spine (Phila Pa 1976)","first-page":"2109","article-title":"Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study","volume":"35","author":"Devito DP","year":"2010","unstructured":"Devito DP, Kaplan L, Dietl R,  Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. 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