Jeremy Steinberger, MD, director of minimally invasive spine surgery at Mount Sinai Health System in New York City, has been on the cutting edge of some technology trends but lagged behind on others, notably robotics.
"I was quick to pull the trigger on certain technologies like navigation. That was something I started early on using in my practice and I was all over it," he told an audience of spine surgeons and ASC administrators at Becker's 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine event. "Then I was skeptical about certain things I've now been proven wrong about. For example, the robot; I kept calling it fancy navigation and said it doesn't add any value to navigation."
But then his system purchased a robot, and he became comfortable with it. Over time, Dr. Steinberger has grown to champion the technology and dubbed it the next phase in the evolution of spine surgery.
"We're using robots to place screws with a little bit of planning involved and extending the screws to the incision and making sure your incision lines up, but I think that's really child's play and if we can take it to the next level of intraoperative decision making, or helping with the decompression and ensuring you have a good adequate decompression of the nerve, you can check if the indirect decompression is enough and you don't need to do a direct decompression for certain surgeries," said Dr. Steinberger. "That kind of next level thinking is where the robot can really transform the game more than it has so far."
Mark Testaiuti, MD, a spinal neurosurgeon, partner and vice president at Coastal Spine in Mount Laurel Township, N.J., sees surgeons being able to use robots as an extension of their hand to remove boney anatomy, expose neural elements, and more.
"It may guide us a bit better and put us in the right place, into that tight foramen or around that nerve root that you might necessarily have as much of a relationship with just visually," Dr. Testaiuti said. "Perhaps there could be other tools developed that link up to the robot in a more fluid manner that assist you in getting to areas with your instruments and being able to use more than just a screwdriver to put in a pedicle screw, but actually guide the survey inside of the canal and disc space going anteriorly."
With the current technology, surgeons can decide whether to take the robot the distance between the front and back of the disc, but guides and other tools could be the next step in technology development.