Why navigation and robotics are not the standard for all spine surgery—lessons learned
BY DR STEFAN MOTOV AND PROF MARTIN N. STIENEN
About the authors:
Dr Stefan Motov is a neurosurgeon specialized in spine surgery. He completed his neurosurgical residency at the Technical University Munich in 2020 and is currently working in the joint neurosurgery/orthopedics center in Kantonsspital St Gallen, Switzerland, focusing on endoscopic, oncological, MIS spine surgery, and interventional pain medicine. Motov is part of the EANS Young Neurosurgeons Committee and the DWG Junges Forum, where he is involved in educational activities for neurosurgery and spine surgery residents in Europe and Germany. He also recently launched a German podcast with his colleague Dr Sami Ridwan on controversies in spine surgery (SpineDocs).
Dr Motov is a member of multiple societies, including the German (DWG) & Swiss Society of Spinal Surgery (SGS), EANS, and AO Spine, where he is involved in educational programs and multiple research collaboration projects.
Prof Dr Martin N. Stienen trained in St.Gallen, Geneva, and Zurich to obtain his board-certification in neurosurgery, followed by fellowship trainings in the US (Stanford University) and Korea (Gangnam Severance University Hospital). He is co-chair of the interdisciplinary spine center at Health Ostschweiz (H-OCH), formerly Kantonsspital St.Gallen, where he supervises a team of 20 physicians and treats a broad variety of spinal pathologies ranging from minimally invasive/endoscopic procedures for degenerative to adult spinal deformity and vertebral column/spinal cord tumors.
Prof Stienen is active in several professional societies, including the AO Spine (past Neuro-Officer Switzerland), EANS Spine Section, German (DWG) & Swiss Society of Spinal Surgery and runs the spinal research lab in St.Gallen, frequently collaborating on multi-center studies with other globally leading institutions.
References and further reading:
- Haider, G., Shah, V., Johnstone, T., Maldaner, N., Stienen, M., & Veeravagu, A. (2023). Accuracy of predicted postoperative segmental lumbar lordosis in spinal fusion using an intraoperative robotic planning and guidance system. J Neurosurg Sci. https://doi.org/10.23736/S0390-5616.23.06142-8
- Huang, J., Li, Y., & Huang, L. (2020). Spine surgical robotics: review of the current application and disadvantages for future perspectives. J Robot Surg, 14(1), 11-16. https://doi.org/10.1007/s11701-019-00983-6
- Keric, N., Doenitz, C., Haj, A., Rachwal-Czyzewicz, I., Renovanz, M., Wesp, D. M. A., Boor, S., Conrad, J., Brawanski, A., Giese, A., & Kantelhardt, S. R. (2017). Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus, 42(5), E11. https://doi.org/10.3171/2017.2.FOCUS16552
- Motov, S., Butenschoen, V. M., Krauss, P. E., Veeravagu, A., Yoo, K. H., Stengel, F. C., Hejrati, N., & Stienen, M. N. (2025). Current state and future perspectives of spinal navigation and robotics-an AO spine survey. Brain Spine, 5, 104165. https://doi.org/10.1016/j.bas.2024.104165
- Patel, N. A., Kuo, C. C., Pennington, Z., Brown, N. J., Gendreau, J., Singh, R., Shahrestani, S., Boyett, C., Diaz-Aguilar, L. D., & Pham, M. H. (2023). Robot-assisted percutaneous pedicle screw placement accuracy compared with alternative guidance in lateral single-position surgery: a systematic review and meta-analysis. J Neurosurg Spine, 39(4), 443-451. https://doi.org/10.3171/2023.3.SPINE2329
- Sankey, E. W., Mehta, V. A., Wang, T. Y., Than, T. T., Goodwin, C. R., Karikari, I. O., Shaffrey, C. I., Abd-El-Barr, M. M., & Than, K. D. (2020). The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States. Neurosurg Focus, 49(5), E20. https://doi.org/10.3171/2020.8.FOCUS20600
- Staartjes, V. E., Klukowska, A. M., & Schroder, M. L. (2018). Pedicle Screw Revision in Robot-Guided, Navigated, and Freehand Thoracolumbar Instrumentation: A Systematic Review and Meta-Analysis. World Neurosurg, 116, 433-443 e438. https://doi.org/10.1016/j.wneu.2018.05.159
- Tarawneh, A. M., Haleem, S., D'Aquino, D., & Quraishi, N. (2021). The comparative accuracy and safety of fluoroscopic and navigation-based techniques in cervical pedicle screw fixation: systematic review and meta-analysis. J Neurosurg Spine, 1-8. https://doi.org/10.3171/2020.11.SPINE201877
- Zhang, J. K., Del Valle, A. J., Alexopoulos, G., Patel, N., Van Nispen, J., Patel, M., Xu, E., Mercier, P., Kohn, N. A., & Mattei, T. A. (2022). Malpractice litigation in elective lumbar spinal fusion: a comprehensive review of reported legal claims in the U.S. in the past 50 years. Spine J, 22(8), 1254-1264. https://doi.org/10.1016/j.spinee.2022.03.015
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