Acute Proximal Junctional Failure Following Long Posterior Fusion for Spinal Deformity: Risk Factors and Radiographic Analysis Comparing Upper Thoracic vs. Thoracolumbar Failures

97% of the implants were rated ‘‘clinically accepted position’’. In 3% the trajectory was misplaced, and intra-operative manual correction was performed. The main reasons for misplacement were planning errors, unstable platform and skiving of the working channel. The total rate of failures decreased from 33% in 2006 to 4% in 2009, with no procedures being aborted in 2008–9. No neurologic complications occurred in this cohort. CONCLUSIONS: Robotic guidance has several clear advantages. The first is the need to pre-planed implants. Subtle anatomical variances of pedicles or trajectories are made clear and simplify the surgical plan. The system is accurate, with 97% clinically acceptable placements. The chances of neurological injury are low (0% in this cohort, 0.7% transient nerve deficit in a multicenter series of 600 cases, 49% percent execute through minimal invasive approaches). The system allows percutaneous and minimal invasive surgery with high levels of safety. The added value of robotic guidance is clear in revision cases, in deformed spine, in multiple level vertebral body augmentation, in percutaneous fracture fixation and in localization of small lesions as Osteoid Osteoma. Further studies will determine cost effectiveness, to assess if better accuracy will lead to better spinal mechanics and to decrease adjacent level degeneration. Robotic guidance, minimized surgical access and time may lead to shorten infection rates and shorter recovery from surgery. FDA DEVICE/DRUG STATUS: Mazor robotic system, Legacy Spinal fixation device, Kyphoplasty: Approved for this indication.