Skip to main content


Log in

Robotics is useful for less-experienced surgeons in spinal deformity surgery

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript



To verify whether robotics was useful for surgeons who had less experience with spinal deformity surgery.


A retrospective review was conducted of 70 consecutive patients who underwent robotic-assisted pedicle screw placements with open procedures using a spine robotic system (Mazor X Stealth Edition) at a single institution from April 2021 to April 2022. Gertzbein–Robbins grades were used to assess the deviation of the 599 pedicle screws in the postoperative CT images. The rate of Grade A was considered the perfect accuracy rate, and the rate of Grades C, D, and E was calculated as the deviation rate. The perfect accuracy rate and deviation rate were compared between the spinal deformity and the non-deformity groups. The perfect accuracy rate, deviation rate, and screw insertion time were compared in the spinal deformity cases between the expert surgeon group and the less-experienced surgeon group.


The deviation rate of the spinal deformity group was higher than that of the non-deformity group even though there was no statistically significant difference (spinal deformity group: 2.3%, non-deformity group: 1.2%, p = 0.350). In the spinal deformity cases, there was no significant difference in the perfect accuracy rate between the expert surgeon group and the less-experienced surgeon group, but the deviation rate was significantly lower in the less-experienced surgeon group (expert surgeon group: 5.0%, less-experienced surgeon group: 0%, p = 0.008). The screw insertion time was significantly shorter in the less-experienced surgeon group.


Robotics is particularly useful for surgeons with less experience in spinal deformity surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

The data sets acquired and analyzed in this study will be disclosed by the corresponding author on reasonable request.


  1. Gruenberg M, Petracchi M, Valacco M et al (2010) The influence of anatomy (normal versus scoliosis) on the free-hand placement of pedicle screws: is misplacement more frequent in patients with anatomical deformity? Evid Based Spine Care J 1:11–17

    Article  PubMed  PubMed Central  Google Scholar 

  2. Baldwin KD, Kadiyala M, Talwar D et al (2022) Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform 10:19–29

    Article  PubMed  Google Scholar 

  3. Park SM, Shen F, Kim HJ et al (2018) How many screws are necessary to be considered an experienced surgeon for freehand placement of thoracolumbar pedicle screws?: analysis using the cumulative summation test for learning curve. World Neurosurg 118:e550–e556

    Article  PubMed  Google Scholar 

  4. Samdani AF, Ranade A, Sciubba DM et al (2010) Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J 19:91–95

    Article  PubMed  Google Scholar 

  5. Lehman RA Jr, Lenke LG, Keeler KA et al (2007) Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine (Phila Pa 1976) 32:2679–84

    Article  PubMed  Google Scholar 

  6. Vardiman AB, Wallace DJ, Booher GA et al (2020) Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery? J Robot Surg 14:567–572

    Article  PubMed  Google Scholar 

  7. Torii Y, Ueno J, Iinuma M et al (2022) Accuracy of robotic-assisted pedicle screw placement comparing junior surgeons with expert surgeons: can junior surgeons place pedicle screws as accurately as expert surgeons? J Orthop Sci.

    Article  PubMed  Google Scholar 

  8. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15:11–4

    Article  CAS  PubMed  Google Scholar 

  9. Chan A, Parent E, Narvacan K et al (2017) Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J 17:1215–1229

    Article  PubMed  Google Scholar 

  10. Akazawa T, Kotani T, Sakuma T et al (2015) Evaluation of pedicle screw placement by pedicle channel grade in adolescent idiopathic scoliosis: should we challenge narrow pedicles? J Orthop Sci 20:818–822

    Article  PubMed  Google Scholar 

  11. Kotani T, Akazawa T, Sakuma T et al (2018) Accuracy of powered surgical instruments compared with manual instruments for pedicle screw insertion: evaluation using o-arm-based navigation in scoliosis surgery. J Orthop Sci 23:765–769

    Article  PubMed  Google Scholar 

  12. Shaw KA, Murphy JS, Devito DP (2018) Accuracy of robot-assisted pedicle screw insertion in adolescent idiopathic scoliosis: is triggered electromyographic pedicle screw stimulation necessary? J Spine Surg 4:187–194

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gonzalez D, Ghessese S, Cook D et al (2021) Initial intraoperative experience with robotic-assisted pedicle screw placement with stealth navigation in pediatric spine deformity: an evaluation of the first 40 cases. J Robot Surg 15:687–693

    Article  PubMed  Google Scholar 

  14. Devito DP, Woo R (2021) History and evolution of spinal robotics in pediatric spinal deformity. Int J Spine Surg 15:S65-73

    Article  PubMed  PubMed Central  Google Scholar 

  15. Morse KW, Heath M, Avrumova F et al (2021) Comprehensive error analysis for robotic-assisted placement of pedicle screws in pediatric spinal deformity: the initial learning curve. J Pediatr Orthop.

    Article  PubMed  Google Scholar 

Download references


No funding was received for conducting this study.

Author information

Authors and Affiliations



JU and YT collected the data. JU and TA wrote and prepared the manuscript. All authors participated in the study design. All authors have read, reviewed, and approved the article.

Corresponding author

Correspondence to Tsutomu Akazawa.

Ethics declarations

Conflict of interest

Tsutomu Akazawa received research support from Medtronic and Globus Medical. The other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Institutional review board of St. Marianna University School of Medicine approved this study. Approval code: No. 5714.

Consent to participate

The opt-out method was adopted to obtain informed consent from the subjects.

Consent for publication

The opt-out method was adopted to obtain informed consent from the subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ueno, J., Torii, Y., Umehra, T. et al. Robotics is useful for less-experienced surgeons in spinal deformity surgery. Eur J Orthop Surg Traumatol 33, 1805–1810 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: