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Letter to the Editor: Spinal Navigation is Not the Same as Robotic Assistance in Surgery

Kanaly, Charles W. MD, FAANS; Backes, Danielle M. PhD

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doi: 10.1097/BRS.0000000000003952
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We were extremely interested to read the study by Yang et al,1 as it purported to study robotic-assisted lumbar fusion. Unfortunately, despite their claim of studying robotic-assisted surgical patients, their study methods reveal that they compared spinal surgery with or without spinal navigation. Patients were selected for their “robotic-assistance” cohort using CPT codes 0054T, 0055T, 20985, and 61783. These CPT codes describe computer-assisted navigation instead of robotics; thus, this cohort would be better described as “navigation-assisted.” Navigation is often part of robotic systems, but the large majority of this cohort likely did not have robotic surgery and instead had surgery with standard spinal navigation (Brainlab, Stryker, Stealth/O-arm, among others). During the 2011 to 2017 time period of this study, spinal robotics had not yet undergone widespread adoption and spinal navigation was much more common. The results and conclusions from this study should be limited to comparing freehand techniques with spinal navigation. Because this was not a study of robotic-assisted surgery, their results and conclusions do not apply to the current modern robotics systems that are being rapidly adopted and have been shown in numerous studies to be superior to conventional techniques.2,3


1. Yang DS, Li NY, Kleinhenz DT, et al. Risk of postoperative complications and revision surgery following robot-assisted posterior lumbar spinal fusion. Spine (Phila Pa 1976) 2020; 45:E1692–E1698.
2. Vaccaro AR, Harris JA, Hussain MM, et al. Assessment of surgical procedural time, pedicle screw accuracy, and clinician radiation exposure of a novel robotic navigation system compared with conventional open and percutaneous freehand techniques: a cadaveric investigation. Global Spine J 2020; 10:814–825.
3. Li H-M, Zhang R-J, Shen C-L. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials. Spine (Phila Pa 1976) 2020; 45:E111–E119.
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