{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:19:17Z","timestamp":1785403157324,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032192","name":"Globus Medical","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032192","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04x4hjg39","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Adult spinal deformity (ASD) correction is a complex surgery to restore spinal alignment and relieve patients\u2019 symptoms. Modern techniques and technologies allow for aggressive surgical correction in tissue-friendly ways that preserve anatomy and may enable faster recovery. Robotic-assisted posterior spinal stabilization may be used as an adjunct to complex ASD reconstruction to facilitate a minimally invasive approach, reduce perioperative morbidity and physiological insult, and allow for the performance of procedures traditionally reserved for large academic centers to be effectively performed by qualified surgeons in optimized patients at smaller hospitals with fewer resources. The objective of this study is to assess realignment, perioperative complications, and patient-reported outcomes of complex, minimally invasive, robotic-assisted adult spinal deformity correction in a surgical specialty hospital. Methods: Demographic, surgical, and perioperative data were collected from the medical record. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for pain scores were collected preoperatively and at regular post-op visits. X-rays were captured preoperatively before hospital discharge and at follow-up visits. Results: Fifty consecutive deformity patients were corrected with a two-stage approach (anterior column reconstruction followed by posterior stabilization with robotic-assisted screw placement on the next day) at a 48-bed (eight operating rooms), surgeon-owned, subspecialty hospital. The average patient age was 70 years, and 64% were female. The average estimated blood loss (EBL) values for the first and second stages were 62 mL and 205 mL, respectively. The average operative time was 172 min during the first stage and 210 min for the second stage. Three interbody spacers (first stage) and 16 screws (second stage) were inserted on average in each procedure. The average length of stay (LOS) in the hospital was 5 days, and the average follow-up period was 10.6 months. No patients required a transfer to another facility with intensive care unit (ICU) capabilities, and none required a revision of hardware placement. There was an average reduction in the lumbar coronal scoliotic curve of 14.5\u00b0 and an increase in lumbar lordosis of 14.8\u00b0 at the latest follow-up (p &lt; 0.01). The average mismatch between pelvic incidence and lumbar lordosis (PI-LL) preoperatively was 17.6\u00b0, which was reduced to 9.6\u00b0 at the latest postoperative follow-up (p &lt; 0.01). Mean ODI (%) and NRS scores were significantly improved by 33.8% (46.7 \u00b1 13.3 to 30.9 \u00b1 19.8; p &lt; 0.01) and 55% (6.0 \u00b1 2.2 to 2.7 \u00b1 2.6; p &lt; 0.01), respectively, at last follow-up. Conclusions: This study demonstrates the feasibility of performing complex, robotic-assisted ASD corrective surgery in a surgical specialty hospital, achieving significant correction of sagittal and coronal deformities, relieving patients\u2019 symptoms, and offering efficiency and consistency to pedicle screw placement. This study demonstrates that a minimally invasive approach to complex deformity reconstruction reduces perioperative morbidity with decreased operative times, EBL, and LOS when compared to historic controls. This approach allows for the democratization of deformity care in that procedures typically reserved for large academic centers can be successfully accomplished at smaller institutions in optimized patients by qualified surgeons with appropriate perioperative support staff.<\/jats:p>","DOI":"10.3390\/jcm15082913","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T08:49:02Z","timestamp":1776070142000},"page":"2913","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally Invasive Robotic-Assisted Complex Adult Spinal Deformity Correction in a Surgical Specialty Hospital: Bringing Adult Spinal Deformity Care Closer to Home"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1294-7030","authenticated-orcid":false,"given":"Roland","family":"Kent","sequence":"first","affiliation":[{"name":"Axis Spine Center, Division of Northwest Specialty Hospital, 7600 N Mineral Dr, Ste 450, Coeur d\u2019Alene, ID 83815, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0140-6736(19)31125-0","article-title":"Adult spinal deformity","volume":"394","author":"Diebo","year":"2019","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.3171\/2010.1.FOCUS09271","article-title":"Adult degenerative scoliosis: Evaluation and management","volume":"28","author":"Silva","year":"2010","journal-title":"Neurosurg. Focus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s00586-018-5816-5","article-title":"Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity","volume":"28","author":"Yagi","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2015.11.SPINE151036","article-title":"Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery","volume":"25","author":"Smith","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1097\/BRS.0b013e31829cb67a","article-title":"Long-term 2- to 5-year clinical and functional outcomes of minimally invasive surgery for adult scoliosis","volume":"38","author":"Anand","year":"2013","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/BRS.0b013e3182a8212d","article-title":"Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: A matched-pair comparison study","volume":"38","author":"Seng","year":"2013","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jocn.2011.10.004","article-title":"Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies","volume":"19","author":"Mobbs","year":"2012","journal-title":"J. Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jspd.2018.08.014","article-title":"The Prevalence of the Use of MIS Techniques in the Treatment of Adult Spinal Deformity (ASD) Amongst Members of the Scoliosis Research Society (SRS) in 2016","volume":"7","author":"Anand","year":"2019","journal-title":"Spine Deform."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s00586-014-3561-y","article-title":"The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity","volume":"23","author":"Costanzo","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.21037\/jss.2019.04.22","article-title":"The utilization of minimally invasive surgery techniques for the treatment of spinal deformity","volume":"5","author":"Wewel","year":"2019","journal-title":"J. Spine Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s43390-020-00180-8","article-title":"State of the art advances in minimally invasive surgery for adult spinal deformity","volume":"8","author":"Hussain","year":"2020","journal-title":"Spine Deform."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2198","DOI":"10.1007\/s00586-017-5012-z","article-title":"S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: Technical note","volume":"26","author":"Hyun","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"20","DOI":"10.14245\/ns.2347138.569","article-title":"Spinal Robotics in Adult Spinal Deformity Surgery: A Systematic Review","volume":"21","author":"Khalifeh","year":"2024","journal-title":"Neurospine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"305","DOI":"10.21037\/jss-23-40","article-title":"Robotic-assisted spine surgery-a narrative review","volume":"10","author":"Antonacci","year":"2024","journal-title":"J. Spine Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1177\/21925682241242449","article-title":"Proficiency Development and Learning Curve in Robot-Assisted Spine Surgery Using the ExcelsiusGPS(R) System: Experience From a Single Institution","volume":"15","author":"Shi","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pham, M.H., Hernandez, N.S., and Stone, L.E. (2024). Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery-A Preliminary Experience. J. Clin. Med., 13.","DOI":"10.3390\/jcm13071829"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4103\/0019-5049.79879","article-title":"American Society of Anaesthesiologists physical status classification","volume":"55","author":"Daabiss","year":"2011","journal-title":"Indian J. Anaesth."},{"key":"ref_18","first-page":"271","article-title":"The Oswestry low back pain disability questionnaire","volume":"66","author":"Fairbank","year":"1980","journal-title":"Physiotherapy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)","volume":"63","author":"Hawker","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study","volume":"37","author":"Schwab","year":"2012","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"661","DOI":"10.3340\/jkns.2018.0150","article-title":"Spinal Deformity Surgery: It Becomes an Essential Part of Neurosurgery","volume":"61","author":"Hyun","year":"2018","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s12178-016-9355-6","article-title":"Role of minimally invasive surgery for adult spinal deformity in preventing complications","volume":"9","author":"Yen","year":"2016","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ishii, K., Watanabe, G., Tomita, T., Nikaido, T., Hikata, T., Shinohara, A., Nakano, M., Saito, T., Nakanishi, K., and Morimoto, T. (2022). Minimally Invasive Spinal Treatment (MIST)-A New Concept in the Treatment of Spinal Diseases: A Narrative Review. Medicina, 58.","DOI":"10.3390\/medicina58081123"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1097\/BRS.0000000000002558","article-title":"Use of Robotic Assistance in Complex Spine Cases","volume":"43","author":"Patel","year":"2018","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1097\/BRS.0b013e31814cf24a","article-title":"Adult spinal deformity surgery: Complications and outcomes in patients over age 60","volume":"32","author":"Daubs","year":"2007","journal-title":"Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3171\/2021.3.SPINE201825","article-title":"Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: Initial analysis of prospectively collected data","volume":"36","author":"Chou","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E813","DOI":"10.1097\/BRS.0000000000002507","article-title":"Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity: Clinical and Radiological Efficacy with Minimum Two Years Follow-up","volume":"43","author":"Park","year":"2018","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S232","DOI":"10.1007\/s00586-012-2344-6","article-title":"Minimally invasive approaches for the correction of adult spinal deformity","volume":"22","author":"Anand","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"16126","DOI":"10.1038\/s41598-025-00510-8","article-title":"Assessment of lumbosacral spinal curvatures before and after surgery using 3D posturography","volume":"15","author":"Bryndal","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Simpson, L., Maharaj, M.M., and Mobbs, R.J. (2019). The role of wearables in spinal posture analysis: A systematic review. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2430-6"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2913\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T04:15:53Z","timestamp":1776140153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,11]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15082913"],"URL":"https:\/\/doi.org\/10.3390\/jcm15082913","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,11]]}}}