The future of spine robots is headed to automation, but the transition to the technology can be smoother than anticipated, Jason Lowenstein, MD, said.
He recently debuted the latest spine robot to launch — Stryker's Mako Spine. Dr. Lowenstein, of Morristown (N.J.) Medical Center, said his first case with the robot was a scoliosis case, and since then he uses it for minimally invasive and hybrid spine surgeries. He said features of Mako Spine that stood out to him included the Q guidance system and its preplanning abilities.
Dr. Lowenstein spoke with Becker's to discuss the areas of spine robotics that excite him the most and strategies to increase adoption.
Note: This conversation was lightly edited for clarity and length.
Question: When you think about new robotic tech overall, what features stand out the most?
Dr. Jason Lowenstein: I think all the robots offer the opportunity to try making surgery more precise, more reproducible, decrease complications and potentially decrease the amount of soft tissue exposure — particularly in an all-percutaneous case or a hybrid construct. It just basically tries to improve accuracy and improve patient recovery, which is all great and so important to try to improve what we're already doing. As robots progress in spine surgery, they'll become more autonomous and more involved in each and every aspect of the surgery.
For example with a navigated burr, I think that will eventually be connected to the robotic arm. Then you can plan your decompression, and the robot will then go into place. You still may put your hands on and help guide it, but it'll be intimately involved in that part of the procedure as well.
Q: What will the learning curve be for that? Do you think there might be some hesitancy in having more automation on spine robots?
JL: There's a learning curve, and I think it takes time to get used to using each part of the platform, and that goes for using navigation. For surgeons that have never navigated instrumentation, there's a learning curve to introduce a new way of trying to perform those types of surgeries. Having said that, I don't think the learning curve is wildly steep. You just have to invest time in doing some cases and get used to it. Companies offer courses to teach surgeons so that they feel more comfortable. I don't think it's an insurmountable challenge at all to try to become comfortable using navigation robotics for spine surgery.
The risk is only that when the robot or the navigation fails for some reason, surgeons obviously have to be comfortable with traditional open techniques as a parachute to bail them out. You have to plan for every possible scenario. Be prepared to make sure they take care of the patient regardless. And when you're doing percutaneous cases, meaning you're placing your hardware through very small stab incisions, you're really relying on the imaging and navigation data to be accurate particularly when you're doing longer constructs, and you're into the thoracic spine, where you risk injuring the spinal cord if you put the screw in the wrong place. You have to be very careful. You have to make sure that you've done all the steps properly. You have to make sure you're checking landmarks to make sure everything's accurate prior to proceeding. There's definitely a lot to consider, but I do think that this is the future, and we will be seeing more and more navigation robotics moving forward in spine surgery.
Q: Are there any other key features that you think will define the next generation of spine robots?
JL: I think incorporating all aspects of spine surgery within the robotic platform is going to be the evolution. Over time there may be the opportunity to have the surgeon not be directly on top of the patient, but utilizing the robot from a short distance. That's probably where robotics will go over time. It's been a big jump just using robotics the way we're using them now, and I think it's going to take time for spine surgeons to feel comfortable using it effectively and making it a win in the operating room.
Q: What advice do you have for surgeons who might be behind the technology curve and want to catch up in 2025?
JL: It's easy to start by going to a course and doing a lab. The other part is that each hospital is a little bit different. Some hospitals have certain imaging platforms already. There's so many different intraoperative X-ray/CT scans available, and a lot of these robots are becoming sort of cross pollinated meaning they can work with different imaging platforms. So it's a combination of figuring out what your hospital has and figuring out how to what they're willing to acquire. Then getting familiarity through labs is the way to go. There is certainly a learning curve, but I think there's an opportunity for all of us to incorporate these techniques. It's just a matter of being interested in doing so.