Robotic spine surgery is gaining momentum, but for Bradley Moatz, MD, orthopedic spine surgeon at Columbia, Md.-based MedStar Health, the conversation is not about whether the technology works.
It is about when it truly matters.
As part of the spine team at Baltimore-based MedStar Union Memorial Hospital, which has performed more than 1,000 robot-assisted spine procedures since 2021, Dr. Moatz has seen firsthand how the technology is reshaping surgical decision-making, not by replacing traditional techniques, but by refining when and how they are used.
“The fact that we have all this technology at our disposal allows us to take on much more difficult cases,” he told Becker’s.
A shift driven by complexity, not convenience
Since adopting robotic technology, Dr. Moatz said his practice has evolved toward treating more complex spinal conditions, cases that previously required longer operative times and carried higher risk.
With robotics, those same procedures can often be performed more efficiently, with less blood loss and greater precision.
“I’m able to take on more complex cases and do them in a fraction of the time,” he said. But that does not mean the robot is used in every case.
In fact, much of its value lies in selective use.
“I’m not using robotics for every single case,” Dr. Moatz said, noting that simpler procedures, such as one- or two-level fusions, are often still performed using traditional freehand techniques.
Instead, he views the technology as a tool best applied in specific clinical scenarios, particularly when surgical complexity increases.
For Dr. Moatz, the tipping point often comes down to anatomy and surgical demands.
Cases involving multiple levels of fusion, typically requiring eight or more screws, are where robotics begins to offer clear efficiency gains.
Patients with very small pedicles, poor bone quality or significant spinal deformity also benefit, as these factors increase the difficulty of achieving precise screw placement using traditional methods.
“In scenarios where there’s a lot of rotation or challenging anatomy, the robot really excels,” he said.
The same is true at both extremes of bone quality. Softer bone allows surgeons to place screws more directly without additional preparation, while extremely dense bone can make traditional techniques more difficult to navigate.
Robotics also reduces reliance on fluoroscopy in complex cases, lowering radiation exposure while improving alignment accuracy.
The learning curve, and what changes with experience
Like most surgical technologies, robotics comes with a learning curve. For Dr. Moatz, that transition took roughly 50 cases.
Over time, the technology began to feel less like an add-on and more like an extension of his surgical approach.
One of the most significant changes was a shift toward less invasive techniques. By reducing soft tissue retraction and adopting a more percutaneous approach, he found that accuracy improved while minimizing disruption to surrounding structures.
“When you’re not tugging on the patient, you’re maintaining alignment, which improves the accuracy of the system,” he said.
At the same time, ongoing software updates and system refinements have continued to streamline workflows, making the technology more efficient over time.
Accuracy, cost and the broader debate
As robotics expands across orthopedics, some studies have raised questions about cost and complication rates, particularly in other specialties.
Dr. Moatz said those findings do not necessarily translate to spine surgery.
“It’s not apples to apples,” he said, noting that his own experience has been overwhelmingly positive. “In my hands, I can’t remember having to revise a screw placed with the robotic system,” he added, citing what he described as near-perfect accuracy.
Still, he acknowledges the financial considerations.
“There are costs associated with using the robot,” he said, adding that ongoing efforts to reduce disposable expenses and improve efficiency are helping to address those concerns.
For many programs, that balance between cost and value will continue to shape adoption decisions.
For health systems looking to build robotic spine programs, Dr. Moatz’s advice is straightforward: start small.
“You want to begin with more straightforward cases and build familiarity,” he said. Rushing into complex procedures too early, he noted, is one of the most common pitfalls.
At MedStar, a hybrid approach has helped manage both cost and workflow. Alongside robotic systems, the team also uses navigation technology, which offers many of the same safety benefits at a lower cost.
“Navigation can be a very helpful starting point,” he said.
That flexibility allows surgeons to scale adoption gradually, rather than relying entirely on robotics from the outset.
A tool, not a replacement
As the role of robotics continues to evolve, Dr. Moatz sees it as part of a broader shift in spine surgery, one that prioritizes precision, efficiency and patient outcomes.
But he is clear about one thing: The technology is not a substitute for surgical judgment.
Instead, it is a tool that, when used appropriately, can enhance decision-making and expand what surgeons are able to do.
“I think it’s only going to improve as time goes on,” he said. As adoption grows, he believes the question will shift from whether to use robotics to how to use it most effectively.
And for surgeons who wait too long to engage with the technology, there may be another risk.
“There’s the potential to fall behind the curve,” he said.
In a field defined by constant innovation, the challenge is no longer access to technology, but knowing exactly where it makes the difference.
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