Dr. Christopher Good: Spinal robots to advance far beyond implant placement

Alan Condon -  

Christopher Good, MD, a spine surgeon with Virginia Spine Institute in Reston, outlines how spinal robots could develop beyond implant placement and have greater autonomy in the OR.

Question: What does the future hold for augmented reality and robotics in spine? 

Dr. Christopher Good: When it comes to the future of augmented reality and robotics in spine surgery, the sky's the limit. First and foremost, powerful 3D software allows surgeons to plan and execute improved surgical procedures. This translates not only into safer implant placement but also better spinal alignment and improved decompression/fusion.

Advanced techniques such as robotic guidance and navigation have already been shown to improve accuracy, decrease complication rates and lead to lower doses of radiation in the OR. In the future, augmented reality and robotic guidance will be used to better plan and execute every step of a spine surgical procedure, going well beyond just placing instrumentation.

Augmented reality heads-up displays will allow surgeons to customize the exact data they need to see while performing a surgical procedure and allow them to visualize that data without having to take their focus away from the patient. Ultimately, this "heads up" visual display can be married with all other types of information including imaging, microscopes and endoscopes. The augmented reality heads-up display becomes the venue through which the surgeon sees all the necessary data that may be used to perform a surgical procedure.

Q: Will spinal robots extend their applications beyond the placement of pedicle screws? What will be the next advancement?

CG: 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. I've also 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 also 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.

Q: Do you see robotic spine systems having greater autonomy in the OR?

CG: This is certainly a hot-button topic. I believe that it will be decades before robots are making autonomous decisions as part of medical or surgical care. That being said, I do see a future where a surgeon uses robotic software to plan a surgical procedure, and then the robotic arm carries out multiple steps autonomously while the surgeon confirms and verifies what the robotic system is doing. This system will never replace the surgeon, but I do believe the mechanical arms will start to do more and more as time goes on.

Q: How will robotics develop in spine surgery as the industry looks for more value-based and cost-effective options to care?

CG: For robotics to develop and gain widespread use, more data and publications are required to define the value add. Our research is showing that robotic guidance leads to lower complication rates and lower risk of revision surgery. When you do a cost analysis looking at the cost of a complication or a revision surgery, the cost to a hospital system to purchase and incorporate robotic guidance can easily be justified. More and more of these studies are showing the accuracy and clinical benefit, but the cost-benefit to the patient, healthcare system and payers must also be demonstrated. I believe robotic systems will allow us to better standardize highly variable spine surgery and that these improved outcomes will more than justify the cost of the technology.

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