{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:58:31Z","timestamp":1785214711570,"version":"3.55.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Unsuccessful intraoperative computed tomography (CT) registration creates significant technical barriers limiting robot-assisted spine surgery implementation in obese populations due to imaging system field-of-view constraints exceeding patient dimensions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      This consecutive series evaluated 63 patients with body mass index exceeding 40 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      undergoing robot-assisted thoracolumbar fusion between October 2023 and November 2024. A lateral reference marker positioning strategy exploited O-arm\u2019s asymmetric spatial coverage (40 cm transverse vs. 15 cm anteroposterior). Systematic preliminary radiographic assessment guided positioning selection, with lateral placement implemented when scout images demonstrated inadequate fiducial visualization or when patient dimensions approached field-of-view limitations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Lateral positioning was implemented in 17 (27.0%) cases. This approach eliminated severe registration failures, with zero patients requiring more than one reattempt compared to 3 (6.5%) patients in the standard positioning cohort requiring two or more reattempts. Ultimate registration success reached 100% across all cases. First-attempt success was achieved in 82.5% of procedures. Patients requiring reattempts demonstrated significantly prolonged O-arm acquisition intervals (30.3 vs. 19.4 min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003) and elevated radiation exposure (61.6 vs. 38.3 mGy,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Optimal pedicle screw positioning (Gertzbein\u2013Robbins Grade A + B) was maintained regardless of technique (lateral 97.6% vs. standard 96.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.650).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Lateral reference marker positioning resolves CT registration challenges in obese patients undergoing robot-assisted spine surgery, achieving universal success using existing equipment without additional capital investment.<\/jats:p>\n                  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