New robotic platforms offer more versatility with integrated navigation and can be used without K wires. Contemporary technologies, including intraoperative CT and new 3D fluoroscopy, offer improved image quality but significantly increase radiation exposure ( 12, 13). Use of a non-invasive, rectangular skin-adhesive stereotactic tracker (SpineMask, Stryker Navigation, Kalamazoo, MI, USA) maintains high accuracy for percutaneous screw placement without requiring bone-anchored tracking or the morbidity of K wires ( 10, 11). Combined with bone anchoring, Renaissance provides pedicle cannulation for K wires and yields high accuracy for screw placement with reduced exposure to radiation ( 8, 9). Renaissance (Mazor Robotics, Caesarea, Israel) was the first widely used spinal robotic platform. This approach also minimises radiation exposure by the surgical team and patient ( 6, 7). Three-dimensional spinal navigation with intraoperative 3D fluoroscopy and bone-anchored (spinous process or iliac crest) tracking provides comparable accuracy without requiring lead protection ( 5). However, these approaches require surgical teams to wear lead protection. The evolution of minimally invasive spine (MIS) approaches introduced 2D fluoroscopy using K wires and EMG neuromonitoring to insert percutaneous pedicle screws and have higher accuracy rates of 90.2–97.5% ( 2, 4). Accuracy of screw placement improves to 86.6–94.9% with 2D fluoroscopy ( 2, 3). Traditional open spine surgery using anatomical landmarks results in rates of free-hand pedicle screw misplacement as high as 40% according to post-operative CT imaging ( 1).
Surgeons and hospital administrators do not have sufficient information to compare imaging, navigation, and robotics technologies when making purchasing decisions.
Contemporary assistive technology options demonstrate a high rate of accuracy for pedicle screw placement. The range of imaging, navigation, and robotics technologies available for spinal fusion surgery has significantly increased. Keywords: 3D fluoroscopy imaging navigation robotics spinal fusion (VII) New robotic arm platforms require more clinical and health economic data to justify increased costs. (VI) Radiation safety awareness that new 3D-fluoroscopy units can deliver radiation comparable to that of CT is needed. (V) Intraoperative CT is more useful for imaging long constructs, high BMI, or cervicothoracic anatomy. (IV) 3D fluoroscopy provides the greatest benefit when speed, operative efficiency, and mobility are required.
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(III) Navigation systems that offer a universal registration mechanism should be standard. (II) Imaging systems that have maximum compatibility with navigation and robotics platforms are optimal.
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(I) Open-platform navigation and robotics systems that provide surgeons with access to all software and hardware features regardless of implant choice are preferred. Key recommendations include the following. Guidelines for optimal use and combinations are provided based on surgical approach, operative site, patient anatomy, optimal image quality, and workflow efficiency. We summarize currently available navigation, robotics, and imaging technologies for spinal surgery, highlighting key characteristics, utility, differences, price, and compatibility with other technologies and spinal implants. However, surgeons and hospital administrators may lack sufficient information to compare options and make purchasing decisions. Abstract: The range of assistive technology options available for spinal fusion surgery has significantly increased.
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