Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends

Marissa D'Souza, Julian Gendreau, Austin Feng, Lily H Kim, Allen L Ho, Anand Veeravagu, Marissa D'Souza, Julian Gendreau, Austin Feng, Lily H Kim, Allen L Ho, Anand Veeravagu

Abstract

Robot-assisted spine surgery has recently emerged as a viable tool to enable less invasive and higher precision surgery. The first-ever spine robot, the SpineAssist (Mazor Robotics Ltd., Caesarea, Israel), gained FDA approval in 2004. With its ability to provide real-time intraoperative navigation and rigid stereotaxy, robotic-assisted surgery has the potential to increase accuracy while decreasing radiation exposure, complication rates, operative time, and recovery time. Currently, robotic assistance is mainly restricted to spinal fusion and instrumentation procedures, but recent studies have demonstrated its use in increasingly complex procedures such as spinal tumor resections and ablations, vertebroplasties, and deformity correction. However, robots do require high initial costs and training, and thus, require justification for their incorporation into common practice. In this review, we discuss the history of spinal robots along as well as currently available systems. We then examine the literature to evaluate accuracy, operative time, complications, radiation exposure, and costs - comparing robotic-assisted to traditional fluoroscopy-assisted freehand approaches. Finally, we consider future applications for robots in spine surgery.

Keywords: Mazor X®; ROSA®; SpineaAssist®; computer assisted navigation; renaissance; robot-assisted surgery; robotic navigation; robotic spine surgery.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 D’Souza et al.

Figures

Figure 1
Figure 1
Following the pre-operative CT, the SpineAssist robotic platform is attached to the spine for final image registration.
Figure 2
Figure 2
SpineAssist workflow of preoperative planning, frame mounting, robot attachment, screw placement and disassembly.
Figure 3
Figure 3
The da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, California) robot. Image courtesy of Intuitive Surgical Inc. da Vinci Si System with single-site instrumentation. Surgeon console, surgeon, da Vinci® Si patient cart with Single-Site™ instruments. Available from: https://www.intuitivesurgical.com/company/media/images/singlesite.php. Accessed September 22, 2019. Copyright © 2019 Intuitive Surgical, Inc.

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