Spine robots have enormous potential to improve their integrations, but companies should explore more ways to make them accessible to wider groups, Grant Booher, MD, said.
Dr. Booher, of Longhorn Brain & Spine in Fort Worth, Texas, spoke with Becker’s about his outlook on surgical robots, artificial intelligence and the next “gold standard” in spine care.
Note: This conversation was lightly edited for clarity and length.
Question: What are spine robots doing great, and what improvements do you want to see when you’re thinking about “spine robots 2.0?”
Dr. Grant Booher: Spine robots are doing a great job of taking a lot of the cognitive load off surgeons. I think any competent surgeon can obviously place pedicle screws, and we’ve got technologies like navigation and the traditional way with a C-arm. Most people would argue they don’t need a machine to help place pedicle screws but I would argue that every competent surgeon should know how to do that.
A lot of people argue that the spine robots will slow them down, and I would challenge anybody to watch my workflow and understand that when you are competent with a surgical robot they can really speed up your workflow.
I’m doing a lot of prone lateral surgeries with the robot, and it’s really changed my workflow quite a bit. But I think the future iterations are going to implement even more. I think we’re going to cross paths with other technologies, like integrating endoscopic approaches with the robot. That may be something that we see down the line in deformity surgery and deformity corrections, and I think we’re going to see rod bending and some of those technologies integrated with the robot.
Q: To what extent are you using AI with either just robotic technologies, or outside?
GB: I don’t feel like there’s a lot of AI technology that’s integrated with the robots currently. I think there’s some ideas and some development with some of the companies on machine learning, like automatic pedicle screw surgical planning.
With true AI, I haven’t seen a whole lot that’s being integrated. I think there’s a lot of room for AI at the clinic to cut down [time] on documentation. The only way I’ve truly utilized AI at this point is if I have to write an appeal letter for an insurance company. I’ll put in some clinical data, and I’ll ask AI to write an appeal letter based on these clinical scenarios and this specific policy. I’ve actually had a lot of success with it, and it’s amazingly accurate.
Q: When you’re thinking about costs of this technology, especially with planning your upcoming ASC, how are you thinking about the investments?
GB: I think those are really big considerations. Most of these robots are obviously multimillion-dollar capital purchases that a small ASC is not able to afford. As these things become more popular the companies are going to have to really work with the systems and the surgeons. They have to get more creative with how they’re bringing these things to market. You can’t buy a $2 million purchase up front, or at least most small centers won’t be able to do that.
They could integrate these things with plans where they can be bought over time and other creative ways of purchasing these. I’m fortunate that there’s some robots that are floating around bigger systems that aren’t being utilized. So being smart about moving them from a hospital, potentially to an ASC is one of the strategies that I’ve seen. But I just think some of these companies are going to have to recognize this and find ways to work with the centers and the surgeons on getting these in places like ASCs.
Q: What are some game changing techniques that physicians should get on board with sooner than later?
GB: I think everyone’s starting to ride this endoscopic wave. It’s not just a trend at this point, and well on its way to becoming the gold standard of spine surgery. Sometimes it is hard to teach an old dog new tricks. It’s very hard to train your mind and say, “OK, let’s change the way that we do this because it’s a little less invasive.” The first endoscopic microdiscectomies that I did took me three hours. But within three or four cases, I’m now down to an hour or less for most of my cases. The proof is in the pudding.
