Virtual Conference
Spine 2023

Bing-Hung Hsu

Taipei Medical University, Taiwan

Title: Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement


ROSA was designed to provide high accuracy for spinal pedicle screw placement through a built-in tracking technique. In 2018, our institute became the first in Asia to utilize ROSA, and this study was conducted from November 2018 to January 2021. The time taken to complete each step of the robotic workflow was recorded. Patient demographics, comorbidities, surgical indications, and number of screw placements were examined in subgroup analysis. The Curve Fitting-General package (a part of NCSS 2021 software) was used to fit a mathematical model to the learning curve. Patient demographics, imaging data, and surgical time were reviewed retrospectively.

A total of 167 patients who had undergone surgery were included. The mean total ROSA usage time was 107.1 ± 27.3 min. The estimated learning rate was 90.4% (88.8%–90.2%), and the largest slope change occurred close to the time of the 20th surgery. The observed overall learning trend in the 4-screw group could be attributed to screw planning. The presence of scoliosis (P = 0.73) or spondylolisthesis (P = 0.70) did not significantly influence the mean total time (TT) for all patients; however, the mean TT differed significantly (P < 0.01) among subgroups stratified by body mass index, screw number placement, and thoracic spine involvement.

To the best of our knowledge, this is the first study to examine the learning curve for the various crucial steps of ROSA-guided pedicle screw placement. The indicative learning curve involved 20 patients who had undergone surgery, and the presence of scoliosis or spondylolisthesis did not significantly influence ROSA usage time. With improved system installation and teamwork, ROSA usage time decreased over time.


Bing-Hung Hsu is an Attending Physician in Neurosugery Department of Taipei Medical University Shuang-Ho hospital and Taipei Neuroscience Institute, and studying at the same time PhD program in Post graduate Institute of clinical Medicine, in Taipei Medical University, Taiwan.