New spinal robotic technologies

doi:10.1007/s11684-019-0716-6

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 Author(s): 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:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-019-0716-6
https://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.)

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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