Robotic spine surgery has allowed surgeons to plan where each pedicle screw and interbody cage will be placed preoperatively, and guides them through that plan during surgery.
Robotic autonomy may increase in the future, but industry leaders believe the best outcomes are achieved when the surgeon has the ultimate say in the operating room.
Here, three surgeons shared their insight on robotic autonomy and the future of the technology in spine:
Note: Responses are lightly edited for style and clarity.
Raymond Walkup, MD. Polaris Spine & Neurosurgery Center (Sandy Springs, Ga.): While robots will never supplant surgeons, they can serve as very useful partners. For example, by using the navigation capabilities rather than fluoroscopy, we can position patients in a fashion that not only gives us better access to the anatomy, but is also more ergonomic. Patient positioning will no longer be restricted to prone, supine or lateral. For example, three-quarter prone position, also known as "park bench," can be used to make a lateral lumbar interbody fusion surgery with percutaneous pedicle screws more ergonomic and efficient, not to mention the drastic reduction in X-ray exposure.
Robotic navigation and placement has also expanded what types of procedures surgeons are comfortable doing in an outpatient setting, making lumbar fusions almost commonplace in an arena where they had previously been a rarity.
K. Samer Shamieh, MD. Avala Hospital (Covington, La.): The future is very exciting for robotic spine surgery. At this point, the robot mainly assists with the placement of pedicle screws. However, I believe that robots will soon be used for docking of retractors, drilling of bone as well as directing certain equipment to take away tissue from the spinal cord and nerves. Whatever the advancements, Avala [Hospital] will be at the forefront of robotic surgery. As far as autonomy, my feeling is that the robot should only assist in the surgery. I feel that the best outcomes are achieved when the surgeon has the ultimate say in the operating room.
Christopher Good, MD. Virginia Spine Institute (Reston): While it is true that spinal robots are still primarily used for placement of pedicle screw instrumentation, it is important to note that robotic guidance can also be used to place any other types of instrumentation, including cortical screws and pelvic screws.
Spinal robots have already advanced well beyond being used solely for instrumentation placement. I have used robotic software and guidance to help plan and execute osteotomies for spinal realignment as well as to guide spinal decompression. I also use robotic guidance to assist with minimally invasive lumbar facet preparation in the setting of minimally invasive fusion and have used robotic/navigation guidance for pelvic reconstruction and sacroiliac joint fusion.
I believe the next tremendous advancement will be using robotic guidance to prepare the interbody space for fusion and to perform fully automated robotic-guided laminectomy/decompression. As these techniques advance and come together, robotics will truly be involved in every step of a spinal surgical procedure, going well beyond just instrumentation placement.