Evaluating the Learning Curve and Surgical Efficacy in the Novel Robotic-Assisted Muscle-Preserving (RAMP) Spinal Decompression

Study DesignComparative cadaveric validation.ObjectivesTo evaluate the influence of prior surgical experience on the accuracy and efficiency of robotic-assisted muscle-preserving (RAMP) decompression using human specimens.MethodsRAMP decompressions were performed from T8 - L5 in 8 cadavers by a non-fellowship-trained surgeon (NFTS) and a fellowship-trained surgeon (FTS). Computed tomography (CT) images were used for preoperative robotic planning and registration. Operative durations were documented, postoperative CT imaging was used to evaluate decompression accuracy and quantified anterior cortical bone removal (ACBR).ResultsA total of 80 levels underwent RAMP decompression (40 thoracic, 40 lumbar). Median single-level operative times were 2.6 min (IQR 1.9-3.7) for NFTS and 2.1 min (IQR 1.6-3.0) for FTS, with no significant difference (<i>P</i> = 0.109). Decompression accuracy demonstrated submillimeter deviation from planned margins, with posterior deviation measuring 0.6 mm (IQR 0.5-1.5) for NFTS and 0.7 mm (IQR 0.4-1.0) for FTS (<i>P</i> = 0.573), and anterior deviation measuring 0.3 mm (IQR 0.1-0.5) in both (<i>P</i> = 0.938). ACBR did not differ significantly between NFTS and FTS. Operative times declined with experience in both surgeons. Initial single-level RAMP decompressions showed greater variability (NFTS: 3.13-8.10 min; FTS: 1.39-10.56 min), while later cases converged to narrower ranges (NFTS: 1.18-2.46 min; FTS: 1.16-2.11 min).ConclusionsThis first comparative cadaveric study evaluating surgeon experience in the novel RAMP decompression demonstrates high accuracy and incrementally improving efficiency regardless of prior robotic experience. These findings support the integration of decompression into robotic workflows and pave the way for a broader applicability of high-precision, muscle-preserving techniques in spine surgery.