Spinal Robotics

Abstract

Even though robotic technology holds great potential for performing spinal surgery and advancing neurosurgical techniques, it is of utmost importance to establish its practicality and to demonstrate better clinical outcomes compared with traditional techniques, especially in the current cost-effective era. Several systems have proved to be safe and reliable in the execution of tasks on a routine basis, are commercially available, and are used for specific indications in spine surgery. However, workflow, usability, interdisciplinary setups, efficacy, and cost-effectiveness have to be proven prospectively. This article includes a short description of robotic structures and workflow, followed by preliminary results of a randomized prospective study comparing conventional free-hand techniques with routine spine navigation and robotic-assisted procedures. Additionally, we present cases performed with a spinal robotic device, assessing not only the accuracy of the robotic-assisted procedure but also other factors (eg, minimal invasiveness, radiation dosage, and learning curves). Currently, the use of robotics in spinal surgery greatly enhances the application of minimally invasive procedures by increasing accuracy and reducing radiation exposure for patients and surgeons compared with standard procedures. Second-generation hardware and software upgrades of existing devices will enhance workflow and intraoperative setup. As more studies are published in this field, robot-assisted therapies will gain wider acceptance in the near future.

Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

“…Full text screening of the remaining 22 articles led to the exclusion of a further 17 articles. In all, 5 articles were identified that satisfied our inclusion criteria, comprising two randomized controlled trials (of which one reported preliminary findings), one prospective cohort, one retrospective cohort, and one cadaveric study (Table 1) [9,11,17,18,20]. A total of 1,308 pedicle screws were reported-729 using robot-assistance, and 579 using fluoroscopy-guidance.…”

“…The other randomized controlled trial by Roser et al [18] reported preliminary findings of a three-arm study comparing fluoroscopy-guided, image-guided (BrainLab VectorVision 2, Feldkirchen, Germany), and robot-assisted pedicle screw placement. The study aims to enroll 90 patients with 4 screws per patient, but has so far recruited 37 patients, with fewer patients undergoing fluoroscopy-guided (n = 10) or image-guided (n = 9) surgery than robot-assisted (n = 18) pedicle screw placement.…”

“…Kantelhardt et al and Lieberman et al [9,11] reported radiation exposure to be significantly less during robot-assisted pedicle screw insertion compared to fluoroscopy-guided procedures, while Ringel et al and Schizas et al [17,20] observed no significant difference in radiation exposure. Roser et al [18] did not perform a statistical comparison on their preliminary findings, but a trend towards reduced radiation exposure in the robot-assisted group was observed.…”

“…In all, 94.1 % (686/729) of pedicle screws placed with robotassistance were satisfactory, compared with 92.7 % (537/ 579) of pedicle screws placed with fluoroscopy-guidance. Ringel et al [17] favored fluoroscopy-guidance (p = 0.019), and the remaining studies supported robotassistance (albeit often not reaching statistical significance) [9,11,18,20]. A forest plot summarizing the odds ratios of the included studies is illustrated in Fig.…”

“…The Jadad system was used to evaluate the quality of the studies by Roser et al and Ringel et al [8,17,18]. Both studies were randomized but the methods to generate the sequence of randomization were not described.…”