15 things to know about robotic spine surgery

Spinal Tech

Robotics is making its mark on the spine industry, promising high accuracy and low complication rates. Here are 15 key notes on the expanding field of robotics in spine surgery. 

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1. The worldwide spinal surgical robotics market is currently valued at $26 million, likely growing to $2.77 billion by 2022, according to a ResearchMoz analysis. The report estimates when spinal robots achieve 35 percent penetration in a country, spinal surgeons will demand hospitals offer spinal surgical robot capabilities.

2. Robotics is intended to boost accuracy and reduce complication rates, according to a ResearchMoz analysis. With the technology, surgeons can pre-plan procedures and achieve reproducible outcomes.

3. A study presented at the Society of Minimally Invasive Spine Surgery Annual Forum 2016 compared the surgical outcomes for 403 robotic-guided spine surgeries with 224 fluoroscopic-guided procedures and 78 freehand procedures.


The complication rates for the techniques were:

• Robotic guidance: 4 percent
• Fluoroscopic guidance: 5.4 percent
• Freehand: 12.8 percent

"This retrospective analysis demonstrated that use of robotic guidance MIS can significantly reduce surgical complications and revision surgeries when compared to fluoro-guided MIS in the hands of experienced MIS surgeons," concluded the study authors.


4. In a study published in the European Spine Journal in March 2011, researchers analyzed 35 patients undergoing percutaneous procedures; 20 undergoing open robotic-guided surgery; and 57 undergoing surgery with open conventional pedicle screw placement. The study revealed robotic-guided pedicle screw implantation yielded a 95.4 percent accuracy rate compared to 91.4 percent accuracy in conventional screw placement.

5. The European Spine Journal study also found an average X-ray exposure per screw of 34 seconds for robotic-guided surgeries compared to 77 seconds for conventional surgeries. 


6. Medtronic placed a purchase order for 15 Mazor Robotics' Mazor X systems in August 2016, as part of it $20 million investment in the company. The Mazor X technology expands on the company's robotic guidance technology to include analytical tools, multiple-source data, precision guidance, optical tracking, intra-op verification and connectivity technologies. Mazor ended the fourth quarter of 2016 with a backlog of 21 systems, including 18 Mazor X systems.

7. Warsaw, Ind.-based Zimmer Biomet acquired Montpellier, France-based Medtech in October 2016. Medtech's original product, ROSA Brain, offers surgeons robotic guidance and preplanning with brain surgery. Based on a preoperative plan, the robot drives the arm along planned trajectories, allowing the surgeon to implement the planned intervention. The company's minimally invasive ROSA Spine, which the FDA cleared in January 2016, involves a similar platform to the brain robot, but is able to adjust for patient movement during surgery.

8. In April 2016, Juan Torres-Reveron, MD, PhD, of Premier Health's Miami Valley Hospital in Dayton, Ohio, performed the nation's first spine surgery using ROSA Spine. The technology guided Dr. Torres-Reveron as he performed a spinal fusion, allowing him to make 1.5 inch incisions and adjusting for patient movement.

9. Audubon, Pa.-based Globus Medical presented its Excelsius GPS investigational robotics system at the North American Spine Society meeting, held in Boston from Oct. 26 to Oct. 29, 2016. The system features non-patient bedside docking and an optical tracking system. The company received the CE Mark for the system in January 2017.


10. Toronto, Canada-based Synaptive Medical's BrightMatter robotic arm is intended to provide visualization of neural structures and soft tissues. Synaptive developed the technology so surgeons could stand upright while operating and still view the monitor.


11. Raynham, Mass.-based DePuy Synthes' spine division unveiled its Kick system, which it developed with Germany-based BrainLab. The system includes FluoroExpress Software, and is designed to offer real-time, intraoperative visualization of instruments and implants in relation to patient anatomy. Surgeons may leverage the navigation to accurately place pedicle screws.


12. A study published in The Spine Journal in November 2016, compared the "biomechanical properties in terms of stress at adjacent segments" after utilizing robot-assisted pedicle screw insertion and freehand for posterior lumbar interbody fusion. The researchers found the robot-assisted insertions demonstrated biomechanical superiority in terms of "alleviation of stress increments at adjacent segments" following fusion, but they warned the sample size was small.

13. A new study published in Clinical Spine Surgery examines patients who underwent spinal deformity correction with robotic guidance for S2-alar-iliac screw insertion. The average screw length was 80 mm and all 31 trajectories were confirmed as accurate. The manual screw insertion resulted in 10 protrusions less than 2 mm, one that was 2 mm to 4 mm and six that were greater than 4 mm. None of the screws were intrapelvic or risked visceral or neuromuscular structures, and none of the screws required removal or revision.

14. Eeric Truumees, MD, CEO of Seton Brain & Spine Institute in Austin, Texas, presented on the economic aspect of navigation and robotic spine surgery at the North American Spine Society annual meeting in Chicago in 2015. Robotics and navigation costs include capital expenses, yearly maintenance and software updates, per case disposables and tech time. It's also important to predict whether the technology will decrease or increase OR time, with a time dependent activity-based costing.


"I think for most of us, this is a very intriguing area, but probably more of a wait-and-see proposition," concludes Dr. Truumees. "…The real take home message is, before you start making decisions on how you change your care, know where you are today and know what your patients really need."

15. In November 2016, William Tobler, MD, of Cincinnati-based Mayfield Brain & Spine, performed the first sacroiliac joint fusion at an outpatient surgery center utilizing Medtronic's RIALTO system in the United States. The RIALTO system features O-arm and StealthStation technology for 3D navigation.

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