The accuracy of robotic systems must be similar to or better than that of well-established methods of pedicle screw placement, including free-hand, fluoroscopically assisted, or computer tomography (CT)–assisted screw placement. Accurate screw placement is therefore fundamental to reducing possible iatrogenic complications and improving surgical outcomes.Ī key determinant of the widespread adoption of robotics in spine surgery is efficient and accurate screw placement. Pedicle screw malposition can lead to serious adverse neurovascular complications, which can contribute to poor outcomes and require reoperation. Pedicle screw placement has emerged a prime area of opportunity for the inclusion of robotics in spine surgery. These advances include the description of open and percutaneous approaches using a variety of navigated techniques ( 6– 11). Techniques for pedicle screw placement were first described in the late 1950s, and since that time, they have undergone a wealth of adaptation and methodological advances. Treatment of spinal pathologies often requires fixation via the placement of pedicle screws. Early incorporation of robotic systems in these fields has spurred innovation and led to their use in other surgical subspecialties more recently, robotic systems have been introduced to the field of spine surgery ( 5).
Early adopters of this technology have included specialties such as general surgery, urology, and gynecology, where robotics have augmented the ability to manipulate tissue in body cavities ( 2– 4).
In the past decade, the role of robotic systems in surgical fields has expanded, and innovations have flourished ( 1). The current state of the field with regard to salient issues in robotics and future directions for robotics in spinal surgery are also discussed. This report provides a technical overview of robotics in spine surgery based on experience at a single institution using the ExcelsiusGPS (Globus Medical Audobon, PA, USA) robotic system for pedicle screw fixation. However, the literature is still lacking with regard to long-term outcomes with these systems. In the past several years, reports have cataloged early results that show the robotic systems are associated with equivalent accuracy and decreased radiation exposure compared with other methods of screw placement. Robotic systems must provide a degree of accuracy comparable to that of already-established methods of screw placement, including free-hand, fluoroscopically assisted, and computed tomography–assisted screw placement.
There is little margin for error with pedicle screw placement, because screw malposition may lead to serious complications, such as neurologic or vascular injury. Surgical procedures involving the spine often require fixation via pedicle screw placement, which is a task that may be augmented by the use of robotic technology. The use of robotic systems in the field of spine surgery has recently begun to be explored. Fields such as general surgery, urology, and gynecology have widely adopted robotic surgery as part of everyday practice. The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Joseph's Hospital and Medical Center, Phoenix, AZ, United States