Current applications of robotics in spine surgery: a systematic review of the literature

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Surgical robotics has demonstrated utility across the spectrum of surgery. Robotics in spine surgery, however, remains in its infancy. Here, the authors systematically review the evidence behind robotic applications in spinal instrumentation.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies (through October 2016) that reported the use of robotics in spinal instrumentation were identified from a search of the PubMed database. Data regarding the accuracy of screw placement, surgeon learning curve, radiation exposure, and reasons for robotic failure were extracted.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-five studies describing 2 unique robots met inclusion criteria. Of these, 22 studies evaluated accuracy of spinal instrumentation. Although grading of pedicle screw accuracy was variable, the most commonly used method was the Gertzbein and Robbins system of classification. In the studies using the Gertzbein and Robbins system, accuracy (Grades A and B) ranged from 85% to 100%. Ten studies evaluated radiation exposure during the procedure. In studies that detailed fluoroscopy usage, overall fluoroscopy times ranged from 1.3 to 34 seconds per screw. Nine studies examined the learning curve for the surgeon, and 12 studies described causes of robotic failure, which included registration failure, soft-tissue hindrance, and lateral skiving of the drill guide.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Robotics in spine surgery is an emerging technology that holds promise for future applications. Surgical accuracy in instrumentation implanted using robotics appears to be high. However, the impact of robotics on radiation exposure is not clear and seems to be dependent on technique and robot type.</jats:p></jats:sec>

First spine surgery utilizing real-time image-guided robotic assistance

“…Robotic assistance has been successfully implemented in many surgical specialties, and has significant potential benefit in spinal surgery. Previous robotic systems have shown improved screw accuracy [4][5][6]11,12], but have significant limitations that have hindered acceptance and widespread use [7,11,13]. A recent systematic review of robotics in spine surgery summarized the most common causes of robotic failure from 12 studies-including registration failure, soft-tissue hindrance, and lateral drill guide skiving [12].…”

How Should Clinicians Communicate With Patients About the Roles of Artificially Intelligent Team Members?

“…1 It can assist surgeons like Dr L in performing procedures such as spinal fixation. 2,3 With a complex technology like the Renaissance System, a series of policies and procedures are important for ensuring its ethical use. These measures include well-designed clinical trials; creation and implementation of procedures before, during, and after surgery, especially concerning complications, errors, and robustness measures; training on the technology's characteristics, uses, and limitations; and how to inform patients about such information.…”

“…For example, beyond merely sharing that she has used this procedure in the past, Dr L should describe studies comparing the Renaissance Guidance System to human surgeons. 2 In this way, the patient's inaccurate perceptions of AI can be countered with a professional assessment of the benefits and risks involved in a specific procedure. While these 2 recommendations are important for proper informed consent, understanding and responding to patients' fears is also essential to good patient engagement and medical care.…”

Spine Surgeons Are Facing the Great Challenge of Contributing to the Realization of a Society of Health and Longevity

“…Recent technical innovations, including imaging technology, applications of artificial intelligence to spine surgery, computer-based navigation systems and robotic technologies are worthy of note, and appear very promising. [6][7][8][9][10][11] We look forward to seeing the brilliant future of spine surgery, although the importance of best surgical…”