• Timothy E O'Connor, Mary Margaret O'Hehir, Asham Khan, Jennifer Z Mao, Lauren C Levy, Jeffrey P Mullin, and John Pollina.
• Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA. Electronic address: toconnor@ubns.com.
• World Neurosurg. 2021 Jan 1; 145: 435-442.

BackgroundMinimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs.MethodsThis paper describes the surgical techniques and operative workflow for placing pedicle screws with the latest robotic technology. The robotic platform, registration, surgical planning, and placement of instrumentation are discussed in detail. Advantages of the Mazor X Stealth Edition compared with the previous generation robot include obviating the need for K wires and eliminating the need for a percutaneous pin, as navigation is integrated into the robot.ResultsOur use of this new technology has been encouraging. Using the techniques described in this paper, the first 90 pedicle screws placed with the Mazor X Stealth Edition robot yielded 100% grade A accuracy on the Gertzbein-Robbins scale confirmed on immediate postoperative CT. There were no complications experienced in any case.ConclusionsIn our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques.Copyright © 2020 Elsevier Inc. All rights reserved.

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