Spine robots have advanced significantly, especially with pedicle screw placement and surgical preplanning. However they’ve also hit a wall in some efficiency, cost and the roles they play in the OR.
Spine surgeons discuss what evolutions are needed, including the role AI can play.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: What’s the most underutilized non-surgical intervention you routinely recommend before considering the OR? Why does it remain that way?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, May 12.
Note: Responses are the individual surgeons’ opinions.
Question: As robotic-assisted spine surgery matures, where do you still see its limitations? What would need to change for you to expand its role?
Milad Alam, MD. DISC Surgery Center at Palm Beach (West Palm Beach, Fla.): I believe that the cost of the robot continues to be a limitation with many facilities. As we all push for more outpatient spine surgery, it would be valuable to have robotic navigation that is portable and can be used in an ASC. I do think that is the direction the industry is heading.
Additionally, it would be helpful to use robotics from a “guidance” system to an “adaptive intelligence” system. The focus would be on having real-time, intraoperative AI assistance, not only for instrumentation, but also for intraoperative planning and feedback.
The robots of the future will hopefully expand capabilities beyond simply placing screws. They will help guide us extensively during decompressions, discectomies, alignment corrections and other procedures.
Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): As robot-assisted spine surgery matures, I am concerned that it will go the way of robot-assisted hip and knee replacement, a niche procedure that few surgeons perform and fewer patients request. There have been several robots that have come and gone with little fanfare. The best robot-assistants will be those that are reimbursable as well as the requisite surgical outcomes. Hospitals and physicians are seeing the squeeze from payers, so adding more time to the schedules and potential complications for less compensation makes the robot a difficult addition to any OR.
Bryan Lee, MD. Barrow Brain and Spine (Phoenix): I am a neurosurgeon specializing in complex spine surgery, with a practice centered on minimally invasive techniques across a broad spectrum of indications, including degenerative disease, revision surgery and deformity correction. Like many other surgeons in the prime of their careers, I have remained deliberately open to adopting emerging technologies to maintain technical precision, stay current and continually refine operative strategies in pursuit of better patient outcomes.
With that mindset, I incorporated robotic technology into my operating room workflow not too long ago. As with any new platform, there is an inherent learning curve particularly when integrating it into an already highly optimized, efficient, and safe surgical system. My established workflow, supported by a consistent and experienced team, functions with the precision of a well-coordinated unit. After performing more than 15 cases using a newly acquired, high-cost robotic system, I found that, contrary to prevailing marketing claims, the robotic workflow did not surpass the efficiency or reliability of my existing techniques utilizing Stealth-based navigation.
In addition to workflow inefficiencies, current robotic platforms introduce practical limitations, including restricted implant compatibility tied to specific vendors. These constraints can impact intraoperative flexibility and decision-making. That said, robotic technology is not without promise. There is clear potential for meaningful advancement not only in workflow integration, but also in mechanical execution and, potentially, accuracy.
We are practicing in an era increasingly shaped by robotics and artificial intelligence. As these technologies evolve, their integration into surgical care will likely become unavoidable. In that context, early exposure and thoughtful adoption are important. Surgeons should engage with platforms that align with their practice style, allowing them to develop familiarity with the technology while critically assessing its value. Ultimately, robotic spine surgery is not yet a replacement for well-established, high-performing workflows but it is a space that warrants ongoing evaluation as the technology matures.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The honest answer is that robotics has solved a problem we were already solving reasonably well — pedicle screw placement accuracy — while leaving the harder problems largely untouched.
Accuracy in instrumentation has improved, and that matters at the margins: complex deformity, revision cases with distorted anatomy, high-risk segments. But the complications that most affect patient outcomes in spine surgery aren’t primarily about screw position. They’re about soft tissue handling, decompression adequacy, fusion biology, patient selection, and the decision of whether to operate at all. Robotics doesn’t touch any of those.
The limitations I see are practical and conceptual. Practically: setup time, OR workflow disruption, cost, and the learning curve for the full team, not just the attending. Conceptually: there’s a tendency to let the technology confer confidence that hasn’t been earned. A perfectly placed screw in the wrong patient is still the wrong operation.
What would change my calculus? Better integration of intraoperative imaging and real-time feedback that addresses decompression adequacy, not just implant positioning. Evidence that robotic-assisted surgery improves patient-reported outcomes, not just radiographic metrics, at a cost that health systems can sustain. And ideally, tools that help us do less, more precisely, rather than tools that make bigger operations feel safer.
I’m not a skeptic of the technology. I’m skeptical of the framing that it represents a fundamental advance in what spine surgery can offer patients.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Granted, attaining competency of any surgical procedure is time and frequency dependent. Up until now, the accepted complication rate for microscopic discectomies approaches infinitesimal, especially with discussions around nerve root injury, dural tears, and inaccurate leveling. Recently witnessed and recurring adversities of robotic assisted surgery such as time intermission, visualization mischance and persistent pain syndrome, accompany growing concerns about standards of care and institutional review. Modifications to the formerly accepted methodologies like open procedures, especially in the more challenging case types, should be encouraged and utilized to avoid life-changing injuries. At this juncture, procedural exchange for a few war-horses is a malapropos choice for some patients and totes an additional form of risk.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
