Spine surgery in 30 years: Will robots replace surgeons?

Robotics

Thirty years from now, every operating room could have a robot for spine surgeries or joint replacements. Robotics has been the buzz word in spine surgery for years, but most surgeons agree the technology is incomplete. That said, what's next for robotics and how far can it go in spine surgery?

Technologies on the market are used as an extension of the surgeon, and the physicians often need to explain to patients that it's not an autonomous robot performing the surgery but rather a robotic-assisted surgery with the surgeon in control of the procedure and making the decisions.

Since 2004, when the Mazor SpineAssist broke into the market, robots have been used to assist surgeons with the placement of pedicle screws. The market has developed rapidly since, with many device companies launching their own versions of spine robots and more in the pipelines.

Although robots are primarily used to assist surgeons with the placement of pedicle screws, those familiar with the technology are quick to point out they can also be used to place other instrumentation, including cortical screws and pelvic screws.

"I have used robotic software and guidance to help plan and execute osteotomies for spinal realignment as well as to guide spinal decompression," Christopher Good, MD, of Virginia Spine Institute in Reston, told Becker's. "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."

Robots have also expanded the types of procedures surgeons are comfortable doing in the outpatient setting, "making lumbar fusions almost commonplace in an arena where they had previously been a rarity," said Raymond Walkup, MD, of Polaris Spine & Neurosurgery Center in Sandy Springs, Ga.

Globus Medical's ExcelsiusGPS system, arguably the leading spine robot on the market, has been used in just 30,000 procedures since it launched in 2017. But robotic utilization — the number of cases performed per installed robot — hit an all-time high in 2021, said Dave Demski, CEO of the company. 

Most significantly, robots allow for smaller incisions, improved precision, less damage to muscle tissue and more reproducible surgeries, which leads to better outcomes and speedier recoveries for patients. In addition, they reduce radiation exposure to both the surgeon, operating room staff and patient.

"We're all concerned about our health and the longevity of our careers and robots decrease radiation exposure for us," Chester Donnally, MD, of Addison-based Texas Spine Consultants, told Becker's. "Unfortunately, I think every spine surgeon knows at least three other spine surgeons who have had some type of cancer. Is that because of all the fluoro or X-ray we're using? Possibly."

Although the benefits of robots are clear, the biggest drawbacks are their cost and size. The going rate for a spine robot is about $1 million. But as the technology develops and more companies launch their own versions of the spine robot, prices are anticipated to come down, making them more accessible to smaller groups and ASCs.

The business model of how robots are sold may also change. with companies linking it to how many cases are performed and developing at-risk models to help pay them down.

It has been almost two decades since robotics arrived in spine surgery. While its future appears bright, the technology is "just beginning to scratch the surface," said Kornelis Poelstra, MD, PhD, director of The Robotic Spine Institute of Las Vegas 

Spine surgery will look different 30 years from now, but most surgeons agree "the robot should only assist in surgery," said K. Samer Shamieh, MD, of Avala Hospital in Covington, La. "I feel that the best outcomes are achieved when the surgeon has the ultimate say in the operating room."

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