Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve

Abstract

The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.

Factors Affecting the Accuracy of Pedicle Screw Placement in Robot-Assisted Surgery: A Multi-Center Study

“…Multiple studies have indicated the presence of a learning curve with robot-assisted surgeries. 22 Avrumova and colleagues reported after the first few cases, the surgeon needed less time to insert the screws with a robot. 23 In another study, 24 the rate of pedicle wall breaches was lower in the second half of cases than in the first half.…”

“…One of the main factors may be the skill of the surgeon performing the procedure. Multiple studies have indicated the presence of a learning curve with robot-assisted surgeries 22. Avrumova and colleagues reported after the first few cases, the surgeon needed less time to insert the screws with a robot 23.…”

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

“…Robotic spinal systems are increasingly used in spine surgery owing to their ability to execute precise, dependable, and efficient procedures [ 44 , 45 ]. Robotic technologies provide a greater precision in pedicle screw fixation and less soft tissue abrasion than other modalities when used with navigation systems [ 46 , 47 ], for example, the fixation of pedicle screws [ 48 ]. Although there is a lack of clinical data addressing the use of robotics in spine surgery, some studies have observed that the precision of pedicle screw fixation achieved by robotic systems is better than that achieved through free-hand (FH) approach or C-arm fluoroscopy-guided pedicle screw fixation [ 42 , 44 , 46 ].…”

“…Robotic technologies provide a greater precision in pedicle screw fixation and less soft tissue abrasion than other modalities when used with navigation systems [ 46 , 47 ], for example, the fixation of pedicle screws [ 48 ]. Although there is a lack of clinical data addressing the use of robotics in spine surgery, some studies have observed that the precision of pedicle screw fixation achieved by robotic systems is better than that achieved through free-hand (FH) approach or C-arm fluoroscopy-guided pedicle screw fixation [ 42 , 44 , 46 ]. Robotic spine surgery can help avoid physical and mental exhaustion of the surgeons, which could lead to better surgical, radiologic, and clinical outcomes [ 49 ].…”

Robotic Spine Surgery: Past, Present and Future.

“…T he first robotic spine surgery (RSS) platform received US Food and Drug Administration (FDA) approval in 2004. Interest in the technology continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques [1][2][3] (Figure 1). The primary goal of this enabling technology is to improve the surgeon's ability to provide predictable and safe outcomes.…”