Spine (Phila Pa 1976). 2026 Apr 21. doi: 10.1097/BRS.0000000000005710. Online ahead of print.
ABSTRACT
STUDY DESIGN: Literature review and international cross-sectional survey with Rasch psychometric analysis.
OBJECTIVE: To evaluate the clinical, economic, and operational impact of navigation and robotics in spine surgery by integrating evidence from the best literature and real-world surgeon practice patterns.
SUMMARY OF BACKGROUND DATA: Robotics and computer-assisted navigation (CAN) are increasingly adopted in spine surgery, with well-documented technical advantages in surgical accuracy and safety. However, their translation into improved patient outcomes, cost-effectiveness, and broad real-world applicability remains uncertain.
METHODS: A scoping review and synthesis of published studies and meta-analyses was performed. In parallel, a 93-item international survey was distributed to spine surgeons across multiple countries, capturing perceptions of accuracy, radiation safety, costs, training, workflow, and patient outcomes. Responses (n = 195) were analyzed using Rasch modeling to assess consensus strength and item difficulty, supplemented by descriptive statistics.
RESULTS: Published data and meta-analyses confirm superior screw accuracy with robotics/CAN (≥95% safe-zone placement) and consistent reductions in staff radiation. Real-world surgeon survey responses showed high concordance on these technical benefits but persistent concerns regarding cost (37.4%), equipment availability (55.9%), workflow burden, and limited training access (8.2%). While 74.9% of surgeons anticipated global adoption as standard of care within 10 years, only 52.3% endorsed cost justification. Rasch analysis demonstrated strong consensus on accuracy and complication reduction but skepticism regarding economic viability.
CONCLUSION: Navigation and robotics in spine surgery offer robust technical benefits but remain constrained by cost, training, and workflow barriers. Balanced integration-expanding applications beyond pedicle screw placement, supported by automation, standardized metrics, and scalable financial models-is essential to realize their full clinical and societal value.
PMID:42023817 | DOI:10.1097/BRS.0000000000005710