Robots and Navigation Revolutionize Spine Surgery

Spine surgery is undergoing a significant transformation thanks to the integration of robotics and navigation systems. These advanced technologies promise to improve the precision of implant placement, reduce radiation exposure, and optimize patient outcomes.

Key Advances in Spine Surgery

• Precision in pedicle screw placement is crucial for the success of instrumented spine surgery.

• Robotic and navigation systems offer a more precise alternative to traditional fluoroscopy-guided techniques.

• Reducing radiation exposure for both the surgeon and the patient is a significant benefit.

• Despite high initial costs and the learning curve, these technologies have the potential to reduce overall patient care costs in the long term.

Evolution of Surgical Precision

Since the pioneers of instrumented spine surgery, the need for greater precision in spinal hardware placement has been constant. Initially, reliance was placed on X-rays, fluoroscopy, and anatomical landmarks. However, even with experienced surgeons, precision was not 100%. This demand for improvement drove the development of intraoperative surgical navigation and robotics.

Types of Robotic and Navigation Systems

Systems for spine surgery are classified into three main categories:

• Supervised control systems: The machine performs predetermined actions with some autonomy, but under the surgeon's supervision.

• Telesurgical systems: The surgeon completely controls the system's movements from a remote command station.

• Shared control systems: Both the robot and the surgeon simultaneously control maneuvers and instruments during the procedure. These are currently the most popular.

Computer-assisted navigation has also gained ground, with platforms like Medtronic's StealthStation and Ziehm Imaging's Ziehm Vision being widely used. Navigation improves the precision of pedicle screw placement and significantly reduces radiation dose compared to fluoroscopic assistance.

Benefits and Challenges of the Technology

The benefits of robotics and navigation include increased precision in pedicle screw placement, reduced radiation exposure, and a potential increase in the reliability and reproducibility of surgical outcomes. However, significant challenges exist.

The main drawbacks are the high capital cost of the technology, which can exceed one million dollars, not including consumables and maintenance. Additionally, the learning curve for robotic systems can be considerable, estimated at around 150 cases for a surgeon to become fully proficient. The learning curve for navigation is less steep, primarily requiring time for intraoperative image acquisition.

The Future of Spine Surgery

Emerging technology is reshaping the practice of spine surgery. Robotics and navigation are becoming increasingly popular as surgeons seek to improve precision, reduce complications, and optimize outcomes. The adoption of these technologies must be carefully weighed against their costs and the associated learning curve.

Sources

• Advancements in robotics and navigation have the potential to transform spine surgery, American Academy of Orthopaedic Surgeons.