Dr. Richard Chua on robotics and spine surgery in 2021

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Richard Chua, MD, of Tucson, Ariz.-based Northwest NeuroSpecialists, spoke with Becker's Spine Review about robot-assisted spine surgery and his outlook for the year.

Note: Responses have been lightly edited for clarity and style.

Question: What effect will COVID have on the adoption of robotic spine surgery? |

Dr. Richard Chua: The COVID-19 pandemic has significantly restricted our ability to do elective spine surgeries, and therefore it will hurt the adoption of robotic techniques, especially for new or early users.

Q: Will hospitals/ASCs be less willing to invest in expensive technologies like robotics?
RC: I think hospitals and ambulatory surgery centers are likely to be less willing to invest in expensive technological advances because of the financial crisis that's likely associated with COVID-19.

Q: What factors will be needed for hospitals and ASCs to be willing to make these investments?

RC: Well, I think the factor that might help hospitals and ASCs as a result of the pandemic is to accelerate strategies to move spine surgeries into an outpatient setting, whether it's done in the U.S. or hospital. The robotic technologies, because of the accuracy and precision of placing instrumentation and the potential for reducing risk and complications with lumbar fusions, may be an ideal time to push us toward a strategy of outpatient lumbar fusions.

Q: Can you talk about the risks that come with robotics in spine surgery? How do surgeons plan and anticipate possible glitches and technical difficulties?

RC: The only risks, specifically with using a robotic system for doing lumbar fusions, is the potential that the technology fails or there's some catastrophic system failure. But if there is no failure, then the robotic technology helps reduce the risk overall of doing spinal fusion surgery, including the risk of nerve injury, spinal fluid leaks, inappropriate position or pedicle screws, all of which may ultimately require revision surgery or secondary surgery.

Q: How are most spine patients viewing robotic spine surgery? Do you receive many patient requests for the technology?

RC: Since the robotic techniques are still very, very new in spinal surgery, it's not widely known by the general public. However, in general, my patients and the general public seem to be very educated, especially with the advancements in the internet and access that they are commonly asking about new techniques and new technologies in spine surgery.

Q: What has your experience been with robotic spine surgery? What areas of spine do you see the tech expanding to in the future?

RC: We have now had approximately two years of dedicated robotic assistants for lumbar fusions, and our patients are absolutely ecstatic with the results and the reduction in risks and complications from spinal surgery. During the pandemic, I have been able to perform spinal fusions, whether they are single-level or multilevel on an outpatient basis, whereas most of these patients would have been hospitalized for somewhere between one to three days, and they haven't.

During different parts of the current COVID-19 pandemic, including now, we are restricted from doing any elective surgeries which require even an overnight hospital stay. Yet there are patients in need of spinal surgery, and now these can be accomplished, including lumbar fusions with the aid of robotic assistants.

Q: What other areas of spine do you see robotics expanding into?

RC: The robotic systems and platforms can and will be used in more advanced applications, such as complex deformity surgery, revision surgery and ultimately in the cervical and thoracic spine.

Q: How do you see artificial intelligence and machine learning affecting spine surgery?

RC: Machine learning, artificial intelligence and data analytics are still very early in their development and applications to spine surgery. But I have no doubt that they will soon become integrated into our surgical techniques, enabling technologies and platforms so that we can even more efficiently and accurately provide or perform spinal surgeries.


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