Becker's ASC Review

56 ORTHOPEDICS Spine surgery in 30 years: Will robots replace surgeons? By Alan Condon T hirty years from now, every operating room could have a robot for spine surgeries or joint replacements. Robotics has been the buzz word in spine surgery for years, but most surgeons agree the technology is incomplete. at said, what's next for robotics and how far can it go in spine surgery? Technologies on the market are used as an extension of the surgeon, and the physicians oen need to explain to patients that it's not an au- tonomous robot performing the surgery but rather a robotic-assisted surgery with the surgeon in control of the procedure and making the decisions. Since 2004, when the Mazor SpineAssist broke into the market, ro- bots have been used to assist surgeons with the placement of pedicle screws. e market has developed rapidly since, with many device companies launching their own versions of spine robots and more in the pipelines. Although robots are primarily used to assist surgeons with the place- ment of pedicle screws, those familiar with the technology are quick to point out they can also be used to place other instrumentation, includ- ing cortical screws and pelvic screws. "I have used robotic soware and guidance to help plan and execute osteotomies for spinal realignment as well as to guide spinal decom- pression," Christopher Good, MD, of Virginia Spine Institute in Res- ton, told Becker's. "I also use robotic guidance to assist with minimally invasive lumbar facet preparation in the setting of minimally invasive fusion and have used robotic/navigation guidance for pelvic recon- struction and sacroiliac joint fusion." Robots have also expanded the types of procedures surgeons are comfortable doing in the outpatient setting, "making lumbar fusions almost commonplace in an arena where they had previously been a rarity," said Raymond Walkup, MD, of Polaris Spine & Neurosurgery Center in Sandy Springs, Ga. Globus Medical's ExcelsiusGPS system, arguably the leading spine ro- bot on the market, has been used in just 30,000 procedures since it launched in 2017. But robotic utilization — the number of cases per- formed per installed robot — hit an all-time high in 2021, said Dave Demski, CEO of the company. Most significantly, robots allow for smaller incisions, improved preci- sion, less damage to muscle tissue and more reproducible surgeries, which leads to better outcomes and speedier recoveries for patients. In addition, they reduce radiation exposure to both the surgeon, operat- ing room staff and patient. "We're all concerned about our health and the longevity of our ca- reers and robots decrease radiation exposure for us," Chester Don- nally, MD, of Addison-based Texas Spine Consultants, told Becker's. "Unfortunately, I think every spine surgeon knows at least three other spine surgeons who have had some type of cancer. Is that because of all the fluoro or X-ray we're using? Possibly." Although the benefits of robots are clear, the biggest drawbacks are their cost and size. e going rate for a spine robot is about $1 million. But as the technology develops and more companies launch their own versions of the spine robot, prices are anticipated to come down, mak- ing them more accessible to smaller groups and ASCs. e business model of how robots are sold may also change. with companies linking it to how many cases are performed and develop- ing at-risk models to help pay them down. It has been almost two decades since robotics arrived in spine surgery. While its future appears bright, the technology is "just beginning to scratch the surface," said Kornelis Poelstra, MD, PhD, director of e Robotic Spine Institute of Las Vegas Spine surgery will look different 30 years from now, but most sur- geons agree "the robot should only assist in surgery," said K. Samer Shamieh, MD, of Avala Hospital in Covington, La. "I feel that the best outcomes are achieved when the surgeon has the ultimate say in the operating room." n $170M Colorado orthopedic hospital pushed back to July 2023 By Alan Condon The opening of Centura Health's hospital under construction in Colorado Springs, Colo., has been delayed to July 2023 because of supply chain disruptions and related issues,THE GAZETTE reported April 4. The delay has increased the cost from $150 million to almost $170 million. The 72-bed hospital, which broke ground in May, will specialize in spine and orthopedics and employ about 400 staff members, according to the report. It will include 10 operating rooms with robotic equipment and 30 beds for surgical preparation and recovery. A medical office building and ASC are also being developed on the 58-acre site. Centura Health officials also changed the name from St. Clare Hospital to St. Francis Hospital-Interquest. n

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