How robots, AI are transforming spinal deformity surgery: Q&A with Dr. Meagan Fernandez

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Meagan Fernandez, DO, recently completed her 200th robotic-assisted pediatric spine surgery at Danville, Pa.-based Geisinger Musculoskeletal Institute.

Dr. Fernandez, section chief of pediatric orthopedics at Geisinger, spoke to Becker's about how robotics is enhancing spinal deformity surgery and the promise of artificial intelligence.

Note: Responses are lightly edited for style and clarity.

Question: How has your view of robotics developed after more than 200 cases with this technology?

Dr. Meagan Fernandez: There is a learning curve when adapting any new technology, but as we've progressed along and gained experience, the system has been tremendous. 

When you are adapting any new technology into your surgical practice you want it to be safe. You also want it to be effective and cost-effective. This Mazor robot completely exceeds all of those requirements for me. In addition, this technology increases my efficiency in the OR and, more importantly, it increases the precision and accuracy with which I perform these cases. 

Robotic assistance in spinal surgery provides many benefits in the operating room for the patient, surgical staff and surgeons. Many studies have demonstrated that robotic surgeries have lower intraoperative complications as well as hardware complications than traditional free hand spine surgery.

Another significant benefit of using the robot is the reduction in radiation exposure to patients, surgeons and the operating room staff. This is especially important because spinal procedures can involve 10- to 12-fold higher amounts of radiation compared to non-spinal procedures.

Q: What are the main cases you use the robot for?

MF: I perform some Scheuermann's kyphosis cases with the robot, some neuromuscular scoliosis cases, but the vast majority are idiopathic scoliosis cases. I'll occasionally do a spinal tumor case.

Q: One view of spine robots, in their current capacity, is they offer more hype than clinical value. What is your stance?

MF: I disagree. The biggest advantage I see with using the robot is the increased precision and accuracy with which I perform these complex surgeries. We're placing screws in slits and deformed pedicles, so if there's any way to improve that safety, to me it's a no-brainer.   

Q: How do you see robots developing in the coming years?

MF: This technology is continually improving and is particularly useful in patients with challenging anatomy. Recently, more pediatric deformity surgeons have adopted robotic technology. I think it is only going to grow. I think it's part of a natural progression as we explore artificial intelligence and go deeper down that path. It's possible that in my lifetime robotic guidance and/or navigation of some sort will become the standard of care for pediatric spinal deformity correction. 

Q: How will artificial intelligence advance spine surgery?

MF: I currently use a patient-specific custom UNiD rod that's created for each individual patient based on their preoperative anatomy. With newer technology combined with AI, future generations of robots have immense potential to improve spine surgery for both patients and surgeons.

Q: Are patient-specific implants the future of deformity surgery?

MF: They really are the future. I think the use of AI in orthopedic surgery holds immense promise. I think its use is going to continue to increase and revolutionize what we do. We're all looking to streamline, standardize and reliably reproduce great outcomes, and that's where AI can help.

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