Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices

BACKGROUND AND OBJECTIVES: Robotic systems have emerged as a significant advancement in the field of spine surgery. They offer improved accuracy in pedicle screw placement and reduce intraoperative complications, hospital length of stay, blood loss, and radiation exposure. As the use of robotics in spine surgery continues to grow, it becomes imperative to understand common errors and challenges associated with this new and promising technology. Although the reported accuracy of robot-assisted pedicle screw placement is very high, the current literature does not capture near misses or incidental procedural errors that might have been managed during surgery or did not alter treatment of patients. We evaluated errors that occur during robot-assisted pedicle screw insertion and identify best practices to minimize their occurrence. METHODS: In this systematic review, we characterized 3 types of errors encountered during robot-assisted pedicle screw insertion—registration errors, skiving, and interference errors—that have been reported in the literature. RESULTS: Our search yielded 13 relevant studies reporting robot-assisted screw errors. Nine studies reported registration errors, with 60% of failed screws in those studies caused by registration issues. Seven studies highlighted skiving errors; 26.8% of the failed screws in those studies were caused by skiving. Finally, interference errors were reported in 4 studies, making up 19.5% of failed screws. CONCLUSION: On the basis of these findings, we suggest best practices—including close attention to preoperative planning, patient positioning, image registration, and equipment selection—to minimize the occurrence of these errors. Awareness of how errors occur may increase the safety of this technology.