Robot Assisted Spine Surgery: A developing technology

Robot Assisted Spine Surgery:  A developing technology

Robot Assisted Spine Surgery: A developing technology

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The technology that allows spine surgeons to perform often complex procedures has grown rapidly in the last two decades. Some of these technologies including minimally invasive endoscopic and laser spine surgery has been joined by robotic assisted spine surgery in the last few years. These technologies have been developed with the potential to offer patient better outcomes and safer operations. To date, many of these technologies has not been proven to be any more effective than traditional approaches. Some surgeons will go as far as to say that these offer more in terms of marketing hype than actual clinical benefit.

Robotic assisted surgery continues to evolve. Robotic surgery has been used in the areas of prostate and gynecologic surgery since the early 2000s. Potential benefits for use of robotic assisted surgery include a shorter hospital stay, less blood loss, few complications, a faster recovery, and less scarring. To date, over 1.5 million surgical cases have been performed worldwide using the da Vinci robot, across several different surgical specialties. The da Vinci robot was used for the first time to perform a successful lumbar fusion in 2012.

Robotic surgery utilizes a magnified 3D vision system and instruments that offer enhanced visualization, precision, and greater control than human hands. The primary use of robotic assisted spine surgery has been for pedicle screw placement so far. To some, the use of robot assisted surgery is about expanding the limits of capabilities to develop newer techniques while other surgeons embrace this type of technology to improve upon outcomes and clinical results for procedures already being done.

A prospective, randomized control trial published in 2012 (Ringel et al), comparing robot assisted pedicle screw placement to conventional fluoroscopic guided placement showed more accurate screw placement in the conventional group, 93% to 85%.

These results have slightly improved over the years. The latest studies now have traditional pedicle screw placement with fluoroscopy either the same as robotic placement or slightly less accurate. In Neurosurgical Focus (2017), a study by Molliqaj G et al, 169 patients underwent placement of pedicle screws between 2007-2015. 98 patients were robot assisted/ 71 were done with a surgeon using fluoroscopic assistance.  The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005).

CONCLUSIONS;  The authors’ retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation owed more accuracy by robot placement (83.6%) compared to conventional fluoroscopy (79.6%).

In summary, robotic assisted spine surgery is growing rapidly and becoming more common. It offers hope for improving surgical outcomes. The full capabilities of this technology are yet to be determined, along with defining what specific conditions can be treated and who the ideal candidate is. More data gradually becomes available, to evaluate whether the push for robotic assisted spine surgery is worth the high initial cost by reducing the rates of revision surgery.

 

Citations

  • Molliqaj G, Schatlo B, Alaid A, Solomiichuk V, Rohde V, Schaller K, Tessitore E. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus. 2017 May;42(5):E14. PubMed PMID: 28463623
  • Solomiichuk V, Fleischhammer J, Molliqaj G, Warda J, Alaid A, von Eckardstein K, Schaller K, Tessitore E, Rohde V, Schatlo B. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus. 2017 May;42(5):E13. PubMed PMID: 28463620

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 
The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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