Table 2.
Main findings of the past studies evaluating the spine robotic surgery systems.
| Study | Robotic surgery system | Sample | Main findings |
|---|---|---|---|
| Lieberman et al. (2006) [60] | SpineAssist (MAZOR Surgical Technologies, Caesarea) and Hover-T frame in conjunction with the PathFinder system (Spinal Concept Inc., Austin, TX). | A cadaver lumbar spine | The average measured discrepancy between the planned and actual screw trajectories by a CT scan was 1.02 ± 0.56 mm. The authors reported that their results support the system's use in minimally invasive spine surgeries. |
| Choi et al. (2000) [47] | Fluorotactic guidance system (Z-Kat, Inc., Miami, FL) | Pedicle screw placement was carried out in six cadavers from T1 to S1 levels | The first fluoroscopy-based system for targeting the location of pedicle screws. The accuracy was similar to a conventional method, especially in the region of T9-L5. |
| Kantelhardt et al. (2011) [48] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | Thirty-five patients underwent percutaneous, 20 open robotic-guided, and 57 open conventional pedicle screw placement. | The accuracy of screw positioning was increased with the use of this robotic system and X-ray exposure reduced. Patients seem to have a better perioperative course following percutaneous procedures. Accuracy of screw placement: Freehand ‐ 91.4 %; Robotic ‐ 94.5 % |
| Schizas et al. (2012) [49] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | 11 patients, (robotic group), and 23 other patients (conventional fluoroscopic group) were instrumented with 64 pedicle screws. | No complications were reported after robotic surgery. Pedicle screw accuracy was 79 % in the robotically assisted group and 83 % in the fluoroscopic group. |
| Ringel et al. (2012) [50] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | 60 patients (Freehand, 152; Robot-assisted, 146). | 93 % of screws had good positions (A or B) in freehand, and 85 % in robot-assisted. Surgical procedure time was lower in freehand (84 min) compared to robot-assisted (95 min) surgery. Most of the malpositioned screws in the robotic surgery group demonstrated a lateral deviation. |
| Schatlo et al. (2014) [51] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | The robot cohort (Group 1; 55 patients, 244 screws) included an initial open robot-assisted subgroup (Subgroup 1 A; 17 patients) and a percutaneous cohort (Subgroup 1 B, 38 patients); fluoroscopy-guided cohort (Group 2; 40 patients, 163 screws) | Accuracy of screw placement: Freehand ‐ 87.1 %; Robotic‐guided Open surgery ‐ 90.4 %; Robotic‐guided Percutaneous surgery‐ 91.9 %. Robot-guided pedicle screw placement is a useful and safe tool for assisting spine surgeons in spine surgeries. However, It was proposed to consider fluoroscopy backup due to technical difficulties. |
| Dreval et al. (2014) [52] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | 77 patients | This system enables minimal-invasive spine interventions with high accuracy (97.2 %) and safety for screw placement. A new technology, Guided Oblique Lumbar Interbody Fusion (GO-LIF), the procedure was performed for microdiscectomy and decompression of the spinal canal. It was reported that the fusion of spinal segments using the GO-LIF was not possible without the SpineAssist robotic system. |
| Molliqaj et al. (2017) [53] | SpineAssist (MAZOR Surgical Technologies, Caesarea) | Robot-assisted cohort (98 patients, 439 screws) freehand fluoroscopy-guided cohort (71 patients, 441 screws) | In the robot-assisted cohort, Grade A perfect (trajectories) were observed for 83.4 % of screws. In the fluoroscopy-guided group, grade A screws were found in 76 % (n = 335). Freehand ‐ 88.9; Robotic ‐ 93.4 |
| Lefranc and Peltier (2016) [65] | The ROSA® robot (Medtech, Montpellier, France) | 38 percutaneous transpedicular screws (between D8 and S1) implanted in two separate cadaver | Thirty-seven screws (97.4 %) were fully contained within the pedicle. The ROSA® Spine robot coupled with intraoperative flat-panel CT can performed highly accurate pedicle screw placement. High accuracy and safety in the treatment of degenerative lumbar disc diseases were reported with this system. |
| Lonjon et al. (2016) [54] | The ROSA® robot (Medtech, Montpellier, France) | ROSA group (10 patients, n = 40 screws); Freehand group (10 patients, n = 50 screws) | Accurate placement of the implant (score A and B) was reported in 97.3 % in ROSA robotic-assisted group and in 92 % of freehand group patients. |
| Solomiichuk et al. (2017) [55] |
SpineAssist (MAZOR Surgical Technologies, Caesarea) | 70 patients with the metastatic spinal disease who required instrumentation (35 patients with robotic surgery) | Accuracy of screw placement (Grade A or B): Freehand ‐ 83.6 %; Robotic ‐ 84.4 % |
| Hyun et al. (2017) [61] | Renaissance Surgical Guidance Robot (Mazor Robotics Ltd., Caesarea) |
robotic-guided and fluoroscopic-guided open surgery (30 patients in each group) | Robotic-guidance surgical procedures reduced radiation exposure and surgical overall time remarkably. Surgical technique did not affect the patient outcomes. Accuracy of screw placement: Freehand ‐ 98.6 %; Robotic ‐ 100 % |
| Kim et al. (2017) [56] | Renaissance Surgical Guidance Robot (Mazor Robotics Ltd., Caesarea) |
Robot: 37 patients; Freehand: 41 patients | Robotic-assisted pedicle screw placement contributed to fewer proximal facet joint violations and better convergence orientations. Accuracy (%): Freehand ‐ 99.4; Robotic ‐ 99.4 |
| Keric et al. (2017) [57] | Renaissance Surgical Guidance Robot (Mazor Robotics Ltd., Caesarea) |
Freehand fluoroscopy-guided surgery: 24 patients percutaneous robot-assisted: 66 patients | Robot-guided pedicle screw placement was effective and safe procedure in thoracic and lumbar spondylodiscitis with lower radiation dose, and decreased complication rates. Accuracy (%): Freehand ‐ 73.5; Robotic ‐ 90 |