*Artificial Intelligence: Development and Applications in Neurosurgery DOI: http://dx.doi.org/10.5772/intechopen.113034*

mentioning that all of these systems are still ultimately controlled by the surgeon. Prospective trials on the SpineAssist system demonstrate up to 99% accuracy with pedicle screw placement, as opposed to the 92% accuracy rate achieved with navigation alone [145]. The robot mounts directly onto the spinous process or other bony landmark and easily interfaces with a CAN system. Retrospective trials and case reports for the ROSA and Excelsius machines show increased accuracy of pedicle screw placement, however the difference was not statistically significant for the ROSA system [145]. Both systems are freestanding which removes the issue of incorrect landmark fixation that can occur with the SpineAssist system, and the Excelsius decreases total radiation exposure. The ROSA, initially created for intracranial neurosurgery, uses a camera and a percutaneous pin system placed over bony landmarks that the robot arm follows. In terms of efficiency, the ROSA is less efficient than current methodologies, adding over 70 minutes to the operative time [145]. Lastly, the Da Vinci system is the most widely used surgical robot though not typically used for and not approved for neurosurgical applications such as spinal instrumentation. Current thinking on potential neurosurgical applications of this device are anterior lumbar fusions [145]. Further randomized trials are needed and likely some adjustments to the systems in order to truly harness the advantages they offer.
