The future of robotics in spine – 3 surgeons share insights


Three spine and neurosurgeons discuss how they see robotics developing in the spine field.

Question: How do you see robotics developing in spine? 

Wellington Hsu, MD. Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery and Director of Research at Northwestern University Feinberg School of Medicine (Chicago): I believe that robotic technology has the potential to revolutionize the efficiency of the spine practice. Although it will take many years to perfect the technology for individual techniques and nuances, in the same way that navigation has changed and improved the way we perform spine surgery, robotics will as well. There is no question that many of the tasks that we perform on a regular basis can be duplicated by automated robotic technology that would allow surgeons to perform more complex tasks with less fatigue. I see the initial role of robotics as automating the simple tasks and allowing the complex ones for the human mind.

Ashutosh Pradhan, MD. Neurosurgeon at St. Vincent's Brain & Spine Institute (Jacksonville, Fla.): Robotic applications are a natural evolution to improving our precision in spine surgery. I think we are very early in its use. Current applications are very limited, but early users will help improve the technology to make it a natural part of the spine surgeon's armamentarium.

William Richardson, MD. Spine Surgeon at Duke Spine Center ( Durham, N.C.): Robotics is in its infancy and currently serves as a drill guide to assist with screw placement. It is as accurate as 3D navigated screw placement but not clearly better. Like spinal navigation it helps protect the surgeon and their staff from radiation exposure but has some potential to increase the exposure to the patient. Companies and surgeons need to pay close attention to the protocols they use to obtain the 3D images to use with the robot or other forms of navigation. 

I am excited to see where robotics takes us. The hope is that it will allow us to perform other parts of the surgical procedure through minimal incisions safely and effectively (decompression, rod bending and placement, and fusion both inter body and posterolateral). Also, with newer software to plan and then analyze what we need can apply AI — or machine learning — to make us better. Until some of these tools are available, we need to focus on surgical flow and process to decrease the learning curve, improve efficiency and demonstrate the value.

I do worry about the impact of these types of technologies on surgical education. It seems that most studies show some percentage of abortion of the procedure due to technical problems and they have to resort to using older approaches. We need to be sure that we train young surgeons in a variety of techniques to effectively care for outpatients when the computer crashes.

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