The case for robotic spine surgery: Will it go mainstream?


The number of spine surgeons using robotic technology across the United States is growing. There is only one FDA-approved robotic spine surgery system — the Mazor Renaissance robotic system — which aims to improve pedicle screw placement accuracy.

"The accuracy is great for the patients and the operating room staff, and it limits the radiation exposure," says Jae Lim, MD, of Atlantic Brain and Spine in Fairfax, Va. "Without robotic guidance you are using a lot of intraoperative X-rays which adds up over time for the OR staff. Minimally invasive procedures without the robot depend on fluoroscopy, but you can't see the open landmarks. With the robotic technology, once you have your trajectory set, it's not hard to look and see that position."


The robotic technology eliminates the need for intraoperative CT scans or X-rays, and the technology allows surgeons to preplan the procedure using a three-dimensional model of the patient's anatomy.


"It's almost like a simulator," says Dr. Lim. "This minimizes the complications and speeds up the surgery because you aren't second guessing yourself about whether the procedure is right. You also remove the time it takes to position the patient and take images."


Despite the advantages Dr. Lim has seen in his practice, there is one major drawback to incorporating this technology more widely: the cost. Hospitals have smaller equipment budgets today than in the past and many initiatives focus on reducing waste. Resource managers will only spend on technology that has significant clinical or cost benefits for the hospital.


"A lot of hospitals are resisting for price, so until there is an overwhelming demand for this technology from surgeons or patients, many hospitals won't have it," says Dr. Lim. "This shift will be driven by technology, economics and insurance issues, so it has to be cost-effective."


Dr. Lim and his colleagues are working on a company-sponsored prospective study to show how the robotic technology can make a difference for patients. The study includes 2,000 to 3,000 patients.


"In order to gain popularity, it has to show clinical and cost-effectiveness," says Dr. Lim. "With any new technology, surgeons have to have an open mind and a certain amount of confidence in the new technology. Many surgeons don't want to try it, but once they do they'll recognize the value."


Typically, Dr. Lim is able to bring the patient in and while the nurses are preparing the patient for surgery, Dr. Lim preplans the procedure based on three-dimensional images. When the patient is ready for surgery, put in the markers for the screws. Calibration takes an extra 10 minutes, but remember you aren't taking extra X-rays during the procedure.


The robotic technology right now is a "guided system," but there could be next generation technology that is semi-active or active.


"The spine can be very finely calibrated," says Dr. Lim. "Where it will be most helpful is when patients have tumors in deep places or when the surgeons need to reset the bone where it's hard to see due to exposure. They'll be able to preplan the robot for accuracy."


There are some patients who arrive at Dr. Lim's office just because they know he uses the robotic technology. "They intuitively know that it's a good thing."


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