Robotics and the spine: a review of current and ongoing applications
T echnological advances have revolutionized spine surgery over the past 20 years. Many of these developments have been centered on the innovations of new technology implants and minimally invasive spine surgery. The goals of these improvements have been to balance the maintenance of a high degree of precision, to minimize risks of damage to neurovascular structures, to facilitate surgeon access and operating room dynamics, and to diminish harmful exposure to ionizing radiation in patients and
... n in patients and the operative team. Because the risks associated with spine surgery are plentiful and limiting complications is imperative, implementing a robot-assisted technique has the potential to address many concerns associated with conventional surgery. Robotic systems have been used in multiple surgical disciplines including gynecology, urology, and general surgery. In the last decade we have seen the application of this technology to spine surgery. Robots can potentially help with all matters of spine surgery including the following: precision in spinal instrumentation, eliminating dural and neurovascular injuries, minimizing exposure to radiation, and improving operating room workflow. 5 At the same time, the technology affords the surgeon a significant improvement in coordination, 3D visualization, and a reduction in fatigue, and it offers the patient a smaller incision, lower risk of infections, minimal muscle retraction and thus postoperative pain, and shortened length of hospital stay. 16 Apart from screw and rod insertion, the technology has been applied to other forms of spine operations and pathological conditions including tumor resections and ablations, vertebroplasties, and anesthetic blocks. 5 This article provides an overview and update on the utility of robotics in spine surgery and spine biomechanics testing. Object. Robotics in the operating room has shown great use and versatility in multiple surgical fields. Robotassisted spine surgery has gained significant favor over its relatively short existence, due to its intuitive promise of higher surgical accuracy and better outcomes with fewer complications. Here, the authors analyze the existing literature on this growing technology in the era of minimally invasive spine surgery. Methods. In an attempt to provide the most recent, up-to-date review of the current literature on robotic spine surgery, a search of the existing literature was conducted to obtain all relevant studies on robotics as it relates to its application in spine surgery and other interventions. Results. In all, 45 articles were included in the analysis. The authors discuss the current status of this technology and its potential in multiple arenas of spinal interventions, mainly spine surgery and spine biomechanics testing. Conclusions. There are numerous potential advantages and limitations to robotic spine surgery, as suggested in published case reports and in retrospective and prospective studies. Randomized controlled trials are few in number and show conflicting results regarding accuracy. The present limitations may be surmountable with future technological improvements, greater surgeon experience, reduced cost, improved operating room dynamics, and more training of surgical team members. Given the promise of robotics for improvements in spine surgery and spine biomechanics testing, more studies are needed to further explore the applicability of this technology in the spinal operating room. Due to the significant cost of the robotic equipment, studies are needed to substantiate that the increased equipment costs will result in significant benefits that will justify the expense. key words • robot • robotics • spine surgery • biomechanics 1 Abbreviations used in this paper: RCT = randomized controlled trial; ROM = range of motion.