Robotic-Guided Spine Surgery
Fellowship-trained spine surgeons • 12 hospital affiliations across New Jersey
Robotic spine surgery combines computer-assisted navigation with robotic guidance to help surgeons place pedicle screws and other spinal implants with a high degree of accuracy. At Atlantic Brain and Spine, fellowship-trained neurosurgical and orthopedic spine surgeons use the Globus ExcelsiusGPS® robotic navigation system to enhance precision during minimally invasive and complex spine procedures. Dr. Kimberly B. Ashayeri also serves as a robotic spine surgery proctor, training other surgeons in the use of this advanced technology. Robotic guidance supports precise surgical planning, minimizes radiation exposure, and helps optimize implant placement while preserving surrounding healthy tissue.
Key takeaways
- The Globus ExcelsiusGPS® robotic navigation system provides sub-millimeter accuracy for pedicle screw placement in cervical, thoracic, and lumbar fusion procedures.
- Robotic guidance reduces pedicle screw malposition rates compared with freehand and fluoroscopy-only techniques, helping reduce the risk of nerve injury and revision surgery.
- Radiation exposure to both the patient and surgical team is significantly reduced because intraoperative fluoroscopy is minimized through CT-based navigation.
- Robotic guidance enhances surgical precision but does not replace the judgment, experience, or decision-making of the spine surgeon.
- Robotic guidance is fully compatible with minimally invasive approaches, enabling percutaneous screw placement through small stab incisions rather than large open exposures.
| Platform | Globus ExcelsiusGPS® robotic navigation system |
| Technology | Computer-assisted navigation with robotic guidance for precise spinal instrumentation |
| Radiation | Reduced intraoperative radiation exposure compared with traditional fluoroscopy-guided techniques |
| Procedures | Cervical fusion, lumbar fusion (TLIF, ALIF with posterior fixation, LLIF), deformity correction, revision surgery, and other complex spine procedures |
| Approach compatibility | Compatible with open and minimally invasive techniques, including percutaneous screw placement |
| ABS expertise | Dr. Kimberly B. Ashayeri serves as a robotic spine surgery proctor at Atlantic Health, helping train other spine surgeons in robotic navigation |
| Hospital stay | Similar to the equivalent non-robotic procedure; robotic guidance does not typically extend recovery time |
Timing and stay vary by patient and complexity. Your surgeon will confirm what to expect in your case.
What robotic guidance actually does
It is important to understand what robotic spine surgery is and what it is not. The robot does not perform the surgery. It does not make decisions, and it does not move independently during the procedure. The neurosurgeon makes every decision and controls every instrument. Robotic guidance is a tool that improves precision it does not determine whether surgery is needed or which operation should be performed.
What the robot provides is precision guidance. Before surgery, the patient’s CT scan is loaded into the robotic planning system. The surgeon uses the software to plan the exact three-dimensional trajectory, length, and diameter of every pedicle screw before the operation begins. In the operating room, the robotic arm holds a drill guide at the surgeon-planned trajectory with sub-millimeter accuracy, ensuring every screw follows the pre-planned path precisely regardless of patient positioning or tissue resistance.
The result is a level of implant placement accuracy that exceeds what can typically be achieved by eye or fluoroscopic guidance alone particularly in complex anatomy, revision cases, or minimally invasive procedures where the screw entry point is not directly visible.
How the Globus ExcelsiusGPS system works
The ExcelsiusGPS (Globus Medical) is a next-generation robotic navigation platform that combines a rigid robotic arm with real-time intraoperative navigation in a single system. Key capabilities:
- Pre-operative plan execution: The surgeon designs the full screw plan on the 3D CT pre-operatively. The robot locks onto the planned trajectory for each screw and holds it precisely during drilling and screw insertion.
- Real-time navigation feedback: Intraoperative 3D imaging (O-arm or CT) can be used to confirm registration accuracy at any point during the case. Any deviation from the plan is immediately flagged.
- Minimally invasive compatibility: Screws can be placed percutaneously through small stab incisions with the same accuracy as open placement. This is particularly valuable for MIS-TLIF and multilevel percutaneous fusion.
- Radiation reduction: Because screw trajectories are guided by pre-operative CT rather than repeated intraoperative X-rays, fluoroscopy time is dramatically reduced benefiting both patient and surgical team.
Overlook Medical Center added the ExcelsiusGPS in 2024, with Dr. Ashayeri serving as the robotic surgery proctor the physician responsible for credentialing and training other surgeons on the platform.
Procedures performed with robotic guidance
Robotic guidance can be used for a wide range of spine fusion and instrumentation procedures, helping surgeons plan implant placement and navigate complex anatomy with greater precision.
- Cervical fusion — Robotic guidance can assist with posterior cervical instrumentation, enhancing precision in one of the most technically demanding regions of the spine.
- TLIF and minimally invasive TLIF (MIS-TLIF) — Robotic guidance supports accurate placement of percutaneous pedicle screws through small incisions, helping preserve surrounding muscles and soft tissues while maintaining implant precision.
- ALIF with posterior instrumentation — After the anterior fusion is completed, robotic guidance is used during the posterior stage to accurately place pedicle screws, creating a stable 360-degree fusion construct.
- Complex deformity and revision surgery — Robotic navigation is particularly valuable when anatomy has been altered by previous surgery, spinal deformity, or other complex conditions, improving surgical planning and implant placement.
- Thoracic fusion — The thoracic spine contains smaller pedicles and lies adjacent to the spinal cord and major blood vessels. Robotic guidance enhances precision in this anatomically challenging region.
Innovation at ABS: single-position lumbar surgery
Dr. Kimberly B. Ashayeri pioneered single-position anterior-posterior lumbar fusion surgery (SPLS) at Atlantic Health. Traditionally, circumferential (360-degree) lumbar fusion requires repositioning the patient during surgery to perform the anterior and posterior portions of the procedure separately. Using robotic navigation, selected patients can undergo both stages in a single position, eliminating the time, blood loss, and anesthesia associated with repositioning while achieving the same surgical goals.
This innovation reflects Atlantic Brain and Spine’s philosophy of using advanced technology only when it provides meaningful advantages for appropriately selected patients.
Benefits and risks
Potential benefits
- Sub-millimeter implant planning and pedicle screw placement improve accuracy, particularly in complex anatomy.
- Reduced reliance on intraoperative fluoroscopy decreases radiation exposure for both the patient and surgical team.
- Supports minimally invasive techniques by enabling accurate percutaneous screw placement through small incisions.
- Particularly valuable for revision surgery, spinal deformity, and multilevel fusion where precision is critical.
Possible risks
- Robotic guidance does not eliminate the inherent risks of spine surgery; neurological, bleeding, infection, and anesthesia risks remain the same.
- Registration errors can occur if patient movement disrupts navigation, although these are identified through intraoperative imaging and corrected before instrumentation.
- System setup adds time at the beginning of the procedure but is often offset by improved efficiency during instrumentation.
- Not every spine operation benefits from robotic guidance. Procedures without spinal instrumentation generally do not require robotic navigation.
Your surgeon will review the benefits and risks specific to your diagnosis during your consultation.
What recovery looks like
Recovery from robotic spine surgery is the same as from equivalent non-robotic procedures -- the robotic guidance improves accuracy but does not itself change recovery:
- Single or two-level lumbar fusion (MIS-TLIF) 1 to 2 nights in hospital. Return to desk work in 2 to 4 weeks. Full activity after fusion confirmed at 3 to 6 months.
- Multilevel or complex fusion 2 to 5 nights. Physical therapy in weeks 4 to 8. Full activity clearance at 6 to 12 months.
- Cervical fusion with robotic posterior fixation 1 to 2 nights. Desk work in 2 weeks. Fusion confirmed at 3 to 6 months.
- Long construct deformity correction 3 to 7 nights, possible short-term rehab. Full recovery 6 to 12 months.
Frequently asked questions
Does the robot perform my surgery?
No. The robot does not move independently, make decisions, or perform any surgical action on its own. It is a guidance tool it holds the drill guide at the surgeon-planned trajectory with sub-millimeter accuracy while the surgeon drills and places each screw. Every decision and action is made by your neurosurgeon.
Is robotic spine surgery safer than traditional spine surgery?
Studies consistently show that robotic guidance reduces pedicle screw malposition rates compared to freehand and fluoroscopy-guided technique. Fewer misplaced screws means a lower risk of nerve injury and revision surgery. For complex cases, high-level deformity, and revision surgery with distorted anatomy, the benefit of robotic accuracy is most significant.
Will I have a longer surgery with robotic guidance?
Robotic system setup and CT registration add 15 to 30 minutes at the start of the case. This is partially offset by faster, more confident screw placement once registered. For multilevel fusions or complex cases, the accuracy of robotic guidance saves time by reducing the need for intraoperative confirmation X-rays and screw revision passes.
Is robotic spine surgery available at all ABS locations?
The Globus ExcelsiusGPS is available at Overlook Medical Center in Summit, where Dr. Ashayeri serves as the robotic proctor. ABS spine surgeons also have access to robotic systems at other Atlantic Health System affiliates. Your surgeon will confirm system availability and discuss whether robotic guidance is appropriate for your specific procedure at your pre-operative appointment.
What is the difference between robotic spine surgery and navigation-guided spine surgery?
Conventional navigation (O-arm, fluoroscopy-based) tracks the position of instruments in real time but does not guide the trajectory the surgeon still aims freehand. Robotic guidance goes further: it holds the drill guide on the surgeon’s pre-planned trajectory, so the screw enters at the exact planned angle regardless of tissue resistance or hand tremor. The combination of 3D planning and robotic arm constraint produces the highest available level of placement accuracy.
This page is for general education and does not replace medical advice. Treatment decisions should be made with a qualified neurosurgeon based on your individual diagnosis and imaging. To discuss your options, call Atlantic Brain and Spine at 973.993.7100 or request a consultation.
Robotic Spine Surgery Specialists at Atlantic Brain and Spine
Your care is provided by Atlantic Brain and Spine's multidisciplinary spine team, including fellowship-trained neurosurgical and orthopedic spine surgeons who use robotic navigation when it offers meaningful advantages for the planned procedure.
