14
SPINE
SURGEONS
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 sur-
geons 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
autonomous robot performing the surgery but rather a robotic-as-
sisted 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,
including 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 de-
compression," Christopher Good, MD, of Virginia Spine Institute in
Reston, told Becker's. "I also use robotic guidance to assist with min-
imally invasive lumbar facet preparation in the setting of minimally
invasive fusion and have used robotic/navigation guidance for pelvic
reconstruction 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
robot 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, according
to Dave Demski, CEO of the company.
Most significantly, robots allow for smaller incisions, improved pre-
cision, 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,
operating room staff and patient.
"We're all concerned about our health and the longevity of our
careers 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 oth-
er 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, making 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 very different 30 years from now, but most
surgeons agree "the robot should only assist in surgery," said K. Sa-
mer 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
Degeneration less
likely with disc
replacement than spinal
fusion, study says
By Carly Behm
C
ervical artificial disc replacements were less
likely to result in degenerative complications
compared to spinal fusions, according to a
study published in the February 2022 edition of the
International Journal of Spine Surgery.
Four things to know:
1. Researchers analyzed patients who had an anterior
cervical discectomy and fusion with patients who had
a cervical disc replacement with follow-up data after
at least two and up to seven years in the wake of the
procedures.
2. A total of 228 patients were examined; 111 had cer-
vical disc replacement and 117 had spinal fusion.
3. The results found the rate of radiographic adja-
cent-level disease was higher in spinal fusion patients.
Rates were lower in artificial disc patients in the superi-
or and inferior adjacent levels.
4. The study concluded: "The difference in radiograph-
ic adjacent-level disease is related to the preservation
of motion at the index level and resultant preserva-
tion of kinematics and forces across the adjacent disc
space." n
