Robotic spine surgery has become a buzzword in the healthcare community. While the technology has been around for several years, it’s just starting to make its way into the forefront of spine care and has gained the interest of many patients who are looking for a less invasive way to address their back pain.
However, as is the case with most new technology, many people wonder how it works, how it differs from traditional, open surgery and whether or not it’s safe.
Is Robotic Spine Surgery Safe?
Robotic spine surgery is one of the safest, most accurate minimally invasive spinal procedures available. Robotic guidance has been used in over 29,000 procedures, helped place over 100,000 implants and been cleared by the FDA. Additionally, it allows surgeons to place implants with over 98% accuracy, reduces patient exposure to radiation and virtually eliminates error of the human hand.
Robotic guidance is a minimally invasive surgical technique that allows the surgeon to access the affected area of the spine using a smaller opening. In traditional, “open spine surgery”, physicians will make a large five to six inch incision down the back, often cutting through muscle and other soft tissue to access and see the affected portions of the spine. However, the truth of the matter is that this surgical technique is unnecessarily invasive and affects more of the anatomy than is actually required.
This is why minimally invasive surgery is becoming the standard for care in most instances of spine surgery.
Accessing the spine through a smaller opening means that there is less blood loss and tissue damage as well a significantly reduced risk of infection following the surgery. This is an incredible benefit considering that, according to the Center for Disease Control, 721,800 infections occurred in hospitals in 2016.
Nevertheless, several studies have found that accessing the spine through a smaller opening decreases the amount that a surgeon can see and, thus, increases the chance that implants won’t be placed as accurately as they would have been in an open format. This is where robotic guidance fits into the picture.
At no time does the machine do any of the operating involved in the surgery, but through the use of computer technology it moves to the exact location where surgeons need to place screws or interbody devices, allowing them to be inserted more quickly and accurately. Robotic spine surgery combines the best of both worlds from minimally invasive surgery and open surgery. It allows surgeons to see exactly what they’re doing and place devices precisely where they need to go, while accessing the spine through a smaller opening.
As a matter of fact, according to a 379-patient controlled study done on robotic spine surgery, people who opt for robotic guidance see 5x less surgical complications during surgery and a seven-fold reduction in revision surgeries needed when compared to traditional, freehand minimally invasive spine surgery.
Doron Dinstein, MD, Chief Medical Officer of Mazor Robotics stated: "Mazor Robotics has been privileged to work with opinion leaders like Dr. Lim in MIS ReFRESH, a highly rigorous scientific study. It is very gratifying for all of us to see the clinical impact of our technology in helping surgeons' better the lives of their patients." The reason that Dr. Lim spend so much time with his patients is because he really cares about what happens in the operating room.
How accurate is robotic spine surgery?
In terms of accuracy, robotic guidance is second to none. A recent study counted 3,271 implants in 635 cases in 14 international medical centers and found that the devices were placed with an average of 98.3% accuracy. For comparison, implants placed solely by the human hand have an accuracy of around 91%.
While this may not seem like a big difference on paper, an implant that is misplaced by even a couple of millimeters can mean continued pain and even repeat surgeries for patients. Which is far from an ideal scenario.
To ensure that implants are placed accurately the first time, before undergoing robotic surgery a neurosurgeon will take a full, three dimensional preoperative scan of the patient’s spine. This allows them to plan exactly how and where they are going to access the spine, mark precisely where any implants and/or devices need to be placed and program it all into a computer before the patient ever enters the operating room.
Just before performing the actual surgery, while the patient is under general anesthesia, the surgeon will take a 3D synchronization of the patient’s spine to ensure that the intraoperative images are matched to their corresponding location on the preoperative scan. Once this has been completed, the robotic software displays precise instruction of where to place the guidance unit and moves to the pre-planned location. This allows the surgeon to accurately and quickly place the implants based on the pre-plan trajectory.
Additionally, since surgeons already have 3D imaging of the patient’s spine, there’s no need to take intraoperative x-rays during surgery which reduces radiation exposure to the patient and operating room staff.
In conclusion, as a physician who has performed over 100 spine surgeries using robotic guidance, I can tell you that this technology is one of the safest used in the field today. It allows surgeons to be more accurate than is typically possible by the human hand while accessing the spine through a smaller, less-invasive opening. This, in turn, lowers complication rates, additional surgeries while allowing for patients to recover quickly and effectively from even the most dramatic spine surgeries.