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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2019, Vol. 13 Issue (6) : 723-729    https://doi.org/10.1007/s11684-019-0716-6
COMMENTARY
New spinal robotic technologies
Bowen Jiang1, Tej D. Azad2, Ethan Cottrill1, Corinna C. Zygourakis1, Alex M. Zhu1, Neil Crawford3, Nicholas Theodore1()
1. Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
2. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
3. Globus Medical, Inc., Audubon, PA 19403, USA
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Abstract

Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA,, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly; however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time — issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.

Keywords robotics      spine surgery      Mazor      ExcelsiusGPS      ROSA      pedicle screw     
Corresponding Authors: Nicholas Theodore   
Just Accepted Date: 04 September 2019   Online First Date: 01 November 2019    Issue Date: 16 December 2019
 Cite this article:   
Bowen Jiang,Tej D. Azad,Ethan Cottrill, et al. New spinal robotic technologies[J]. Front. Med., 2019, 13(6): 723-729.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-019-0716-6
http://academic.hep.com.cn/fmd/EN/Y2019/V13/I6/723
Fig.1  Globus ExcelsiusGPS® robot with intraoperative navigation station. (Copyright permission obtained from Globus Medical.)
Fig.2  Overhead schematic showing positioning and workflow with the Globus ExcelsiusGPS® robot. (Copyright permission obtained from Globus Medical.)
Feature Mazor
SpineAssist® Renaissance® X™ X™ Stealth
Manufacturer Mazor Robotics; Caesareas, Israel Medtronic; Dublin, Ireland
FDA Approval (year) 2004 2011 2016 2018
Preoperative CT required Yes Yes No No
Mount Bone Bone Bone Bone
Instrument tracking No No Yes Yes
Guide wires required Yes Yes Yes Yes
Additional features Small frameless platform Small frameless platform Mazor X™Align application Medtronic’s Stealth navigation
Feature ROSA ExcelsiusGPS™
Spine ONE Spine
Manufacturer Zimmer Biomet; Warsaw, IN Globus Medical; Audubon, PA
FDA Approval (year) 2016 2019 2017
Preoperative CT required No No No
Mount Floor Floor Floor
Instrument tracking Yes Yes Yes
Guide wires required Yes Yes No
Additional features Real-time dynamic guidance Platform can also treat brain and knee pathologies Surveillance of navigation integrity and skiving
Tab.1  Comparison of robotic systems that have been approved by the FDA for spine surgery.
Fig.3  (A) Preoperative computed tomogram (CT), (B) intraoperative clinical photograph, and (C) immediate postoperative CT of a septuagenarian male patient presenting with an unstable traumatic T8 burst fracture in the setting of ankylosing spondylitis. This patient was treated with a T6-T10 instrumented spinal fusion with robotic assistance using the ExcelsiusGPS™ robotic system.
Fig.4  (A & B) Preoperative and (C & D) postoperative computed tomograms of a tricenarian female patient presenting with a chin-on-chest deformity in the setting of a previous spinal epidural abscess treated with an anteroposterior C5-C7 corpectomy and reconstruction, which was complicated by an infection with subsequent removal of the posterior hardware. This patient was treated with a C2-T4 instrumented spinal fusion for deformity correction with robotic assistance using the ExcelsiusGPS™ robotic system.
Fig.5  (A) Preoperative radiograph, (B) preoperative magnetic resonance imaging, (C) intraoperative fluorograph, and (D) 7-month postoperative radiograph of a quadragenarian female patient presenting with a severe kyphotic deformity of approximately 90° in the setting of vertebral osteomyelitis and discitis causing virtually complete destruction of T11 and T12. This patient was treated with a T8-L3 instrumented spinal fusion with a T11-T12 corpectomy and expandable interbody cage with robotic assistance using the ExcelsiusGPS™ robotic system.
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