'A fool with a tool is still a fool': How spine surgeons should approach robots


Spine surgery robots are on the rise, but they're no substitute for mastering spinal anatomy, Brian Gantwerker, MD, said at Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC +The Future of Spine Conference.

"They say a fool with a tool is still a fool, so just because you have fancier, more expensive tools, if you can't operate then it's not going to get better," Dr. Gantwerker said. "It's all about the anatomy, and I think that the problem with robots … You've got to understand the anatomical relationships between the structures and unfortunately what robots and some other enabling technologies do is perhaps allow people who maybe shouldn't be doing spine surgery to do [it]."

The spine market includes Globus Medical's ExcelsiusGPS, Medtronic's Mazor X and Brainlab's Cirq. And Stryker is planning to launch its spine robot toward the end of 2024.

These robots also come with a learning curve for physicians in any stage of their careers, but having experience can help surgeons master new technology faster. 

A 2023 study published in Spine found it was easier for surgeons experienced with minimally invasive transforaminal lumbar interbody fusions to incorporate robotic technology into their practice than it was for early career attendings. The surgeon in the study with 16 years of experience didn't have a discernible learning curve or difference in operative or fluoroscopy time between any of the patients. Meanwhile the less experienced surgeons had an ongoing learning curve, and one reached mastery at 31 cases.

Dr. Gantwerker said spine surgeons should be able to see a patient's anatomy and understand what they're looking at instead of just relying on what a screen is showing. 

"Training people initially just on the robot is a huge mistake and hopefully it's not being perpetuated," he said.

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