Editors: Alexander R. Vaccaro, MD; Jaykar R. Panchmatia, MA; I. David Kaye. MD;   and Srinivas K. Prasad, MD
Publisher:  Thieme – 211 pages, with 125 illustrations
Book Review by: Nano Khilnani

The specific aim of this book is to fill the need for techniques-based knowledge in the use of robotics in spine surgery. While robotics in itself is a relatively new method in surgeries of all kinds, and has many advantages over traditional surgery, its use is still not widespread because of the challenges posed by what is often referred to as a ‘learning curve’, both in knowledge and practice of the do’s and don’ts specific to spine surgery.

The editors express optimism: “As these technologies become more mainstream, early adopters are paving the way for more widespread adoption and navigated and robotic systems are now routinely found in community medical centers.”

They point out the following facts to support their optimism:

  • In 2016, the robotics industry market was worth $4 billion, and is expected to grow by 75 percent to almost 75 percent to $7 billion by 2026
  • The robotics market in spine surgery is expected to grow in turn, expanding the current (2020) market capitalization of approximately $75 million to $320 million by 2026

But some considerations need to be taken into account before these new technologies are widely accepted.

The editors explain: “However, several barriers to broader acceptance exist.” We itemize them below, using the exact their exact words in the Preface:

  • Increased upfront costs
  • Intrusion on the current workflow
  • General lack of understanding of precisely how these technologies can enhance the surgical experience and potentially improve patient outcomes

We believe these barriers will be overcome, for the benefit of both spine surgeons and their patients, as knowledge and practice increases.

The publication of this book is a concrete example of how that knowledge and practice is spreading. Eighty-eight specialists in neurosurgery, orthopedics, orthopedic surgery, and spine surgery from all over the United States and five other countries – Canada, China, Italy,  Japan, and the United Kingdom – authored the 34 chapters of this book that provides a look at the use of robotic techniques in spine surgery.  We name the chapters below to provide you an overview:

  1. Part I – Introduction to Navigation and Robotics
  2. Principles of Navigated pedicle Screw Placement
  3. Three-Dimensional Computer-Assisted Navigation platforms
  4. Intraoperative Ultrasound in Spine Surgery: A Versatile and Useful Adjunct
  5. Magnetic Resonance Imaging-Based Navigation
  6. Shared Control Robotics
  7. Telesurgical Robots
  8. Supervisory-Controlled Robotics
  9. Radiation Exposure and Navigated Spinal Surgery
  10. Part II – Techniques for Navigation-Assisted Spine Surgery
  11. Outcomes in Navigated Spinal Surgery
  12. Navigated Subaxial Cervical Spine Pedicle Screw Instrumentation
  13. Navigated Anterior Transoral Surgery for C1 and C2 Pathologies
  14. Navigated Posterior Correction of Pediatric Scoliosis
  15. Navigated Posterior instrumentation of the Arthrodesed Spine
  16. Navigated Minimally Invasive Transforaminal Lumbar Interbody Fusion
  17. Robotic Instrumentation for Lumbosacral Spondylolisthesis
  18. The Role of Navigation in the Resection of Primary Spinal Tumor
  19. Surgical Management of Thoracolumbar Spinal Metastases Using Navigation
  20. Navigated Pelvic Fixation
  21. Navigated Sacroiliac Joint Fusion
  22. Navigation Balloon Kyphoplasty
  23. Part III – Techniques for Robotic-Assisted Spine Surgery
  24. Outcomes in Robotic Spinal Surgery
  25. Robotic Subaxial Cervical Spine Pedicle Screw instrumentation
  26. Navigated and Robotic Anterior Odontoid Peg Fracture Fixation
  27. Navigated and Robotic Posterior Atlantoaxial Fusion
  28. Robotic Posterior Thoracic Pedicle Screw Placement
  29. Robotic Minimally Invasive Transforaminal Lumbar Interbody Fusion
  30. Robotic Anterior Lumbar Interbody Fusion
  31. Part IV – Techniques Using Alternative Modalities for Complex Spine Pathology
  32. Intraoperative Ultrasound-Guided Intradural Tumor Resection
  33. Stereotactic Radiosurgery for Treatment of Primary and Metastatic Spinal Tumors
  34. Part V- Easing the Transition to Technological Adoption
  35. Operating Room Design and Efficiency
  36. Mounting the Learning Curve with New Technologies
  37. Part VI – Future Directions
  38. Artificial Intelligence
  39. What We Can Learn From Other industries
  40. Future Growth in Navigated and Robotic Spinal Surgery

This book is an admirably pioneering effort of 88 people in six countries to not only make the lives of people better using emerging navigation and robotic technologies in spine surgery, but to pass on to their colleagues around the world on how to do so, with their gems of information and insight found in this book. Kudos to the brilliant editors and authors!



Alexander R. Vaccaro, MD, PhD, MBA is the Richard H. Rothman Professor and Chairman of the Department of Orthopedic Surgery, Professor of Neurosurgery at Thomas Jefferson University and Hospitals, and President of the Rothman Institute in Philadelphia, Pennsylvania.

Jaykar R. Panchmatia, MA, MPH, MB BChir, FRCS is Consultant Spine Surgeon at Guy’s and St. Thomas Hospitals in London in the United Kingdom.

I David Kaye, MD is Assistant Professor of Orthopedic Surgery at Thomas Jefferson University and Hospitals, and Spine Surgeon at the Rothman Institute in Philadelphia, Pennsylvania.

Srinivas K. Prasad, MD, MS is Associate Professor of Neurological Surgery, and Director of the Neurological Spine Fellowship at Thomas Jefferson University and Hospitals in Philadelphia, Pennsylvania.