The next generation of spine surgery robots may go beyond just hardware advances and become a learning partner alongside surgeons, Michael Gallizzi, MD, said.
Dr. Gallizzi, a spine surgeon at The Steadman Clinic in Vail, Colo., spoke with Becker’s about what’s needed to boost spine robot adoption and his predictions for the next generation of systems.
Note: This conversation was lightly edited for clarity.
Question: Although there’s a lot of talk about robotics and minimally invasive spine surgery, the data from the American Spine Registry shows a plateau. What do you think about this gap?
Dr. Michael Gallizzi: I’ve read that report and have seen the flattening sales of spine systems. I started using Globus Medical’s platform in 2019, so I was kind of on the earlier side of adoption. I think the problem with robotics is the high capital equipment cost, and because navigation already exists, it’s hard to convert someone who typically only does a one- or two-level surgery with navigation to change their workflow. And when there’s two competing systems, people either believe in it or they say they don’t find using it any faster or it slows them down with additional setup. That in combination with decreased reimbursement across all of healthcare is just shrinking the pool of available funds to make large capital equipment purchases.
Q: What do you think really needs to change in just the system or just the way surgeons are taught to grow adoption?
MG: What you’re exposed to in residency and fellowship tends to dictate which path you’re going to take. In a traditional program where you’re doing a lot of open cases and maybe a little bit of MIS, you might say, “This works, good enough, and this is what I am going to do.” More and more robotic platforms are now being installed at teaching institutions, as opposed to just in the private practice. There’s a lot of competition at systems on the coast, and some in the middle of the U.S. In Colorado, people use it, but they don’t necessarily like it. I use it every time, which is why my numbers keep growing.
Some people selectively use it, but if you’re a selective user, you aren’t benefiting from repetition and getting your work flow faster. If you only do one or two cases a month with the robot, the team doesn’t get dialed in.
Q: What’s your five-year outlook for spine robots?
MG: We’ve got the first-generation robots pretty dialed in, and then there’s going to be the next generation. That is going to have AI functionality to it where it learns how you plan your screws, and auto-drops the screws. They could have multiple arms instead of a single arm or be able to automate some small, planned steps. I think the next wave of robotics will be using combinations of learning from its surgeon and have that deep learning, machine learning to start saying how surgeons should plan their surgery. They may start giving actual feedback to the surgeon based on anatomic detail, or trying to line screws up better automatically. I think it’s going to be a combination of the hardware being more fine-tuned with articulating arms, or multiple bends to the arm, and the software actively learning from its users and then applying that knowledge to expedite some perceived longer parts of the workflow.
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