Spine surgeons adopting robotic-assisted and endoscopic techniques face widely varying learning curves, with research showing large differences in the number of procedures needed to achieve proficiency, according to an editorial published in the fall 2026 issue of Vertebral Columns.
The editorial was written by seven authors from Rush University Medical Center in Chicago, Case Western Reserve University in Cleveland and The Ohio State University in Columbus, including Kern Singh, MD, and Daniel Park, MD, of Rush’s orthopedic surgery department.
The editorial examined how surgeons develop proficiency with emerging spine surgery technologies and the challenges of establishing consistent benchmarks. A 2026 systematic review of 29 studies found surgeons needed an average of 20 cases to reach proficiency in uniportal endoscopic spine surgery, compared with 37.5 cases for biportal procedures.
Learning curves also varied in robotic-assisted spine surgery. A review of 14 studies found that 80% of the improvement in operating time occurred after 46 cases, while 90% of surgeons reached a plateau after 369.1 cases. Screw accuracy reached 80% of its improvement after 217 screws, while blood loss reached the same improvement threshold after an average of 65 cases.
Despite these findings, the authors said that differences in study methods, outcome measures and surgeon experience make learning-curve benchmarks difficult to compare. They said standardized, risk-adjusted assessments that account for patient complexity and surgical complications are needed.
The authors also said structured training, simulation and mentorship can help surgeons develop proficiency while limiting patient safety risks as new technologies are adopted.
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