Development of a Robotic Spine Surgery Program

Abstract

Surgical robots were invented in the 1980s, and since then, robotic-assisted surgery has become commonplace. In the field of spine surgery, robotic assistance is utilized mainly to place pedicle screws, and multiple studies have demonstrated that robots can increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. However, this may be at the cost of longer operative times, complications, and the risk of errors in mapping the patient's anatomy.Obtaining robotic technology for spine surgery often involves administrative hurdles and a high up-front investment. While the financial cost may be recouped through potential cost savings and benefits from marketing, surgeons and staff must first overcome the learning curve with this technology. Once streamlined, robotic spine surgery (RSS) may potentially aid in more complex procedures as its role continues to expand. Advances in computer processing, artificial intelligence, and technological improvements will improve RSS, but it is still critical for surgeons to maintain expertise in traditional surgical techniques as strict dependence on robotic and navigation technology is dangerous.This article provides a brief history of RSS, describes currently available spinal surgery robots, and presents the efficacy, risks, and complications of RSS procedures. It also delineates the cost, reimbursement, learning curve, safety monitoring, and future applications of RSS.Robotic-assisted spine surgery is a rapidly developing technology, and its use is becoming common in practice. Devel-oping a robotic spine surgery (RSS) program faces many challenges, including difficulty obtaining robotic technology, training surgeons and hospital staff, navigating through the learning curve, managing surgeon scheduling of procedures, and monitoring quality and outcomes. Surgeons, practices, and institutions interested in acquiring RSS technology should be aware of the history of robotics in spine surgery, the complications associated with RSS, and the necessary steps for developing a successful RSS program. History and Current Use of Robots in SurgeryIn the early 1980s, robotic surgery was born with investment from the National Aeronautics and Space Administration (NASA) as scientists struggled to solve the problem of providing surgery to astronauts in orbit 1 . In the years following these preliminary experiments, investment flowed to the private sector, and surgeons in operating rooms (ORs) on earth began experimenting with new technologies 2 . In 1989, Computer Motion developed the Automated Endoscopic System for Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H45).

Application of continuous intraoperative neuromonitoring in the study of spinal nerve root thermal injury in a porcine model

“…The advent of automated spinal robots is anticipated to partially supplant human operators in performing bone-cutting procedures in the future [1,2,19]. Unlike manual operations, which are dependent on the operator's experience, these robotic systems have the potential to exert more intelligent control over heat generation.…”

“…The eld of spinal surgery has witnessed rapid advancements with the development of surgical robots, primarily semi-automated robots designed to assist in pedicle screw placement. [1,2]. These robots, while enhancing precision, are on the cusp of full autonomy, capable of executing complex procedures such as pedicle screw placement and laminectomy [3,4].…”

Machine Learning in Spine Surgery: A Narrative Review

“…46 Semiautomated systems using ML have already been developed to complement existing ORs. [47][48][49][50][51] One example is a positioning model that automatically adjusts the C-Arm to desired angles to reduce surgical time, manual acquisitions, and radiation exposure. 52…”

History and Future of Spinal Cord Stimulation

“…Spine surgery has advanced with a better understanding of sagittal balance and new techniques that lead to better outcomes. 75,76 However, SCS technology has also advanced with newer leads and stimulation paradigms associated with improved outcomes. In fact, data now support using SCS for patients with low back pain who have never undergone lumbar decompression with or without fusion.…”