Robotic Spine Surgery: Current State in Minimally Invasive Surgery

Vo, Chau D.; Jiang, Bowen; Azad, Tej D.; Crawford, Neil R.; Bydon, Ali; Theodore, Nicholas

doi:10.1177/2192568219878131

Cited by 65 publications

(43 citation statements)

References 48 publications

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“…Furthermore, the complex processing capabilities provided by AI could provide immediate feedback that not only allows for real time analysis, but anticipates dynamic changes intraoperatively. 88 While the transition to completely autonomous robotic spine surgery is unlikely in the near future, AI and ML can be used to negotiate continuous feedback between the human operator and machine with the goal of improved performance and clinical outcomes.…”

Section: Robotics and Surgical Planningmentioning

confidence: 99%

Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making

Mallow

Siyaji

Galbusera

et al. 2020

Global Spine Journal

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Section: Robotics and Surgical Planningmentioning

confidence: 99%

Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making

Mallow

Siyaji

Galbusera

et al. 2020

Global Spine Journal

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“…To date, there are 3 robots available in the US that are approved by the FDA for PS placement: Mazor X Stealth Edition (Medtronic), ExcelsiusGPS (Globus Medical), and ROSA (Zimmer Biomet). 7 Mazor led the market with the first and most extensively used robotic spine surgery platform. 8 ROSA aims at operating as a more universal neurosurgery robot; it was previously used for cranial procedures and has recently acquired FDA approval for spine surgery with the release of the ROSA ONE Spine platform.…”

mentioning

confidence: 99%

Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis

Naik

Smith

Shaffer

et al. 2022

Neurosurgical Focus

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OBJECTIVE Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. METHODS A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. RESULTS Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. CONCLUSIONS The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.

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“…Given the risks of aberrant instrument placement during decompression, further research/work is required to improve this issue of accuracy particular with robotic navigation of instruments like a burr or Kerrison punch. Advancements in the communication between navigation software and robotic instrumentation holds the key to use of a robot for spinal decompression procedures (24).…”

Section: Future Research and Innovative Technologymentioning

confidence: 99%

Narrative review of intraoperative imaging guidance for decompression-only surgery

Virk¹,

Qureshi²

2021

Ann Transl Med

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Decompression of the spine is defined as removal of bony and soft tissue structures in order to provide space for the spinal cord and/or nerve roots. This definition, however, underscores the dangers and complexity of safely providing anatomical space for these neurologic structures. Complications such as neurologic injury, vascular injury, and durotomy can make these procedures hazardous for the patient and surgeon. Furthermore, inability to fully decompress the neural elements will result in continued symptoms for patients. Intraoperative image guidance can provide important anatomical landmarks to perform these decompressive surgeries safely and efficiently. In particular, performing decompression surgery utilizing minimally invasive techniques with image guidance can allow for the least amount of muscle/soft tissue trauma possible. Within our article we outline research on the forefront of use of intra-operative imaging guidance for spine surgery and implications for decompression surgery. We also outline a case from the senior author to illustrate an example of image-guided spine decompression for cervical radiculopathy.Future technology, such as augmented reality and robotics, is also discussed in the context of image guided decompression. The authors hope this article shows surgeons that use of image guidance in specific clinical situations can allow for better/safer spinal decompression procedures.

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Robotic Spine Surgery: Current State in Minimally Invasive Surgery

Cited by 65 publications

References 48 publications

Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making

Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making

Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis

Narrative review of intraoperative imaging guidance for decompression-only surgery

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