How Do Robotics and Navigation Facilitate Minimally Invasive Spine Surgery? A Case Series and Narrative Review.

Background and objectives: Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS.

Methods: A retrospective chart review was conducted to obtain data for patients who underwent RA lumbar fusions with real-time navigation for degenerative lumbar pathology between September 1, 2021, and January 1, 2024. The Mazor X Stealth Edition (Medtronic) robotic platform was used. The accuracy of screw placement was determined according to Gertzbein-Robbins classification. Intraoperative and postoperative complication rates up to 90 days were recorded. Intraoperative variables and length of stay were compared between open and percutaneous groups.

Results: A total of 247 patients underwent insertion of 1156 pedicle screws. The mean patient age was 61.1 ± 11.5 years. The mean total operative time was 195.1 ± 80.8 minutes. The mean operative time per screw was 4.2 ± 1.4 minutes, with a mean of 4.6 ± 1.4 screws per case. The mean fluoroscopy time per screw was 6.4 ± 6.2 seconds. Eighty-five patients (34.4%) underwent open RA pedicle screw placement, and 162 (65.6%) underwent percutaneous RA pedicle screw placement. No differences in operative time, length of stay, fluoroscopy time, and surgical complications were found between groups. Intraoperatively, 2 patients (0.8%) experienced complications and 4 patients (1.6%) developed complications within 90 days. Screw placement accuracy was perfect in 1126 screws (97.4%) and clinically acceptable in 30 screws (2.6%). These results were consistent with those reported in the literature.

Conclusion: Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.