The Journal of Neurosurgery's Neurosurgical Focus May 2017 edition includes a systematic literature review of the current application for robotics in spine surgery.
The study authors examined all studies through October 2016 from the PubMed database using robotics in spinal surgery. They conducted the review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and focused on data for screw placement, learning curve, radiation exposure and robotic failure.
There were 25 studies describing two robotic systems that met the criteria, and 22 studies reported accuracy of the spinal instrumentation. Here are five things to know:
1. The Gertzbein and Robbins classification system was the most common method for examining pedicle screw accuracy; in studies using that method, accuracy ranged from 85 percent to 100 percent.
2. There were 10 studies evaluating radiation exposure; those studies found fluoroscopy times overall were 1.3 seconds to 34 seconds per screw.
3. Of the 12 studies examining robotic failure, the reasons included:
• Registration failure
• Soft tissue hindrance
• Lateral drill guide skiving
4. There were eight studies examining the learning curve for the spinal instrumentation; in one study, the screw placement ability was 83.7 percent for the total cohort and increased to 90.8 percent for the most recent procedures. Another study found the learning curve for successful placement was around 30 procedures.
5. The studies examined found surgeons increased accuracy, decreased screw placement time and decreased conversion rate with experience.
"Robotics in spine surgery is a new technology that holds promise for future applications," concluded the study authors. "Currently, placement of pedicle screws with robotics appears to be safe, and accuracy appears to be superior to freehand placement, although the data are not conclusive."