Hospitals and surgery centers across the U.S. have been implementing robots that are designed to improve surgical precision and provide more reproducible spine surgeries.
Three spine surgeons discuss where we are with spinal robots today and what future applications the technology may be used for.
Note: Responses are lightly edited for style and clarity.
K. Samer Shamieh, MD. Avala Hospital (Covington, La.): The future is very exciting for robotic spine surgery. At this point, the robot mainly assists with the placement of pedicle screws. However, I believe that robots will soon be used for docking of retractors, drilling of bone as well as directing certain equipment to take away tissue from the spinal cord and nerves. Whatever the advancements, Avala will be at the forefront of robotic surgery. As far as autonomy, my feeling is that the robot should only assist in the surgery. I feel that the best outcomes are achieved when the surgeon has the ultimate say in the operating room.
Christopher Good, MD. Virginia Spine Institute (Reston): While it is true that spinal robots are still primarily used for placement of pedicle screw instrumentation, it is important to note that robotic guidance can also be used to place any other types of instrumentation, including cortical screws and pelvic screws.
Spinal robots have already advanced well beyond being used solely for instrumentation placement. I have used robotic software and guidance to help plan and execute osteotomies for spinal realignment as well as to guide spinal decompression. I also use robotic guidance to assist with minimally invasive lumbar facet preparation in the setting of minimally invasive fusion and have used robotic/navigation guidance for pelvic reconstruction and sacroiliac joint fusion.
I believe the next tremendous advancement will be using robotic guidance to prepare the interbody space for fusion and to perform fully automated robotic-guided laminectomy/decompression. As these techniques advance and come together, robotics will truly be involved in every step of a spinal surgical procedure, going well beyond just instrumentation placement.
Kornelis Poelstra, MD, PhD. The Robotic Spine Institute of Silicon Valley (Los Gatos, Calif.): The future for robotics is bright. In addition to trajectory guidance to place hardware and perform complex preoperative planning procedures, robots are soon going to be able to have greater autonomy in the OR, I hope. We must discuss these advances together with regulatory bodies such as the FDA, but this autonomy will not be far off.
Robotic systems should be able to nearly autonomously place hardware, further reducing outliers and human error, help us with discectomy procedures and end plate preparation in a more predictable form as well as with decompression surgery of the spinal canal. Utilizing advanced learning, I am confident that we can start manipulating muscle and fascia and have robotic assistance soon that will help us open and close surgical approaches.
People should also not forget the highly advanced predictive analytics that help us with the decision-making processes of which surgical technique to offer to which patient. Robotic and computer systems are much more capable of analyzing large amounts of variables to help us reduce complications and make better choices for our patient population.