Journal of Pediatric Orthopaedics - 2026-09-16 - Journal Article
Utilizing Robotic-Assisted Navigation in Early Onset Scoliosis: Experience From a Multicenter Registry.
Williams CJ, Marsh IG, Sullivan ML, Hedequist D, Erickson MA, Hogue GD, Birch CM, Hresko MT, Ross KE, Murphy RF, Devito DP, Widmann RF, Heyer JH, ASPIRE Study Group
Topics
Key Takeaway
Robotic-assisted navigation achieved 97% screw placement success across 710 attempted screws in EOS patients, but robotic technical challenges occurred in 34% of cases.
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Summary
This multicenter registry study evaluated robotic-assisted navigation (RAN) in 64 EOS patients (mean preoperative Cobb 67±18°) across 9 institutions between 2022 and 2025. Robotic screw success rate was 97% (710/730 attempted), with 9 malpositioned screws (1.3%) all identified and corrected intraoperatively. Technical challenges occurred in 34% of patients (22/64), most commonly loss of calibration (14%) and registration failure (11%), with a 16% postoperative complication rate.
Key Limitation
Absence of a concurrent control group using freehand or fluoroscopy-guided techniques makes it impossible to determine whether the 1% malposition rate and 16% complication rate represent an improvement, equivalence, or inferiority compared to conventional methods in EOS.
Original Abstract
BACKGROUND
Early onset scoliosis (EOS), defined as scoliosis presenting in patients 9 years of age and younger, presents unique surgical challenges, including dysplastic and narrow pedicles that heighten the risk of pedicle breach and neurovascular injury during scoliosis surgery. Robotic-assisted navigation (RAN) has demonstrated improved pedicle screw placement accuracy compared with conventional freehand and fluoroscopy-guided techniques; however, data on its application in the EOS population remain limited. This study characterizes the intraoperative experiences, technical challenges, and postoperative complication profile associated with RAN in a multicenter EOS cohort.
METHODS
A prospectively collected, multicenter registry of pediatric patients undergoing spine surgery utilizing RAN across 9 institutions was queried for patients with a diagnosis of EOS treated between January 2022 and April 2025. Demographic, clinical, and surgical characteristics were presented using descriptive statistics. Postoperative complications, including unplanned return to the operating room, infection, and neurological events, were reported in patients with a minimum of 90-day follow-up.
RESULTS
Sixty-four patients met the inclusion criteria (mean follow-up: 13 mo, range: 0 to 35); 63% had idiopathic scoliosis, 25% neuromuscular, and 13% other (congenital/syndromic). Mean preoperative curve magnitude was 67±18 degrees. Most patients (88%) underwent a posterior spinal fusion, 11% underwent a growth-friendly surgical procedure, and 2% underwent a revision of a prior growth-friendly construct. A total of 710 robotic screws were placed. Robotic screw success, defined as an attempted screw placed without difficulty or malposition, occurred in 97% of attempted screws overall (710/730), with a mean per-patient success rate of 94%±14%. Malpositioned screws were identified intraoperatively via ball-tipped probe palpation of the pedicle tract and fluoroscopy. Robotic challenges occurred 35 times in 22 patients (34%). Issues with registration (7, 11%) and loss of calibration (9, 14%) were the most frequent challenges encountered. There were 9 malpositioned robotic screws (1% of robotic screws) in 8 patients (13%), all of which were addressed intraoperatively. Nine patients (16%) had a postoperative complication. Two patients had an unplanned return to the operating room, 1 for proximal junctional kyphosis and 1 for deep surgical site infection.
CONCLUSION
This study describes the current perspective associated with the use of RAN in a heterogeneous EOS population, with a high rate of robotic-related technical challenges but a low rate of screw inaccuracy.
LEVEL OF EVIDENCE
Level III evidence.