By: 30 January 2017
Robot-guided, less-invasive spinal surgery is no myth

Robot-guided spinal surgery benefits patients by not only lowering tissue damage but also minimising recovery time. Bhawna Rath looks into how robotic technology is making inroads into spinal surgery.

Robotic technology is one of the greatest new advances in orthopaedic surgery, especially within spinal surgery. To begin looking into this new trend, let’s start with something that has been around for a while, such as the use of computers as a form of navigation. Industry experts at Allied Market Research say computer navigation is the single biggest advance when it comes to spinal surgery in the past 16 years. It has enabled doctors to shift from rudimentary or traditional medical devices, ranging from alignment tools and cutting platforms to robots that provide both precision as well as accuracy.

Spinal surgeries can be extremely dangerous as the spine is close to the blood vessels and nerves. Moshe Shoham, founder and chief technical officer of Mazor Robotics, explains that if we are to look at statistics of hand surgeries, the cases of misplaced screws and nerve damage accounts for about 10 per cent and 3.5 per cent, respectively. Mazor Surgical Technologies was identified as an authorised manufacturer and marketer of SpineAssist, a miniature robot that ensures fail-proof spinal surgery in 2005. Expressing his sentiments about the product Shoham said: “SpineAssist minimises the risk of working free-hand in sensitive regions of the spine.”

The professor highlights that robotics has completely revolutionized the spinal surgery. He added, “It conceives a plan for locating the spinal implants, but neither replaces the surgeon nor performs any operations. After examining and approving the recommendation, the surgeon inserts surgical instruments through the arm of the robot, thereby minimising the danger of damaging vital organs.”

The technology also ensures less fluoroscopy, a more speedy recovery as well as less invasive procedures. Furthermore, the technology provides paramount results for the patients, doctors and the medical institution. Can the robots help the doctor limit the number of vertebras the surgeon wants to fuse? Definitely, this is where the machine plays into the support plan. Robots have increased the safety as well as accuracy of surgery and the technology has opened new avenues for the orthopaedic devices market.

Neurosurgeon Juan Torres-Reveron performed the first ROSA spine surgery in May  2016 in the USA. Torres-Reveron believes robotic spine surgery will bring about a dramatic shift in how medical practitioners perform minimally invasive surgery. Commenting on the computer–assisted surgery, Torres-Reveron said: “It’s just a computer. If anything, the hardest part is going to be trusting. You have to trust the robot and believe it’s going to be correct.”


Control in the orthopaedic devices market

Spine surgeons are always expected to be in control during an operation, with a plan B and C ready in case something goes wrong during the operation. In such instances robotic technology plays a vital role in the pre-op planning. So why are surgeons reluctant to use medical robots for spinal surgery? Mainly because they do not want to give up their positions. What surgeons should never forget is they have to be in control with or without robots or a smart device. Machines can screw in a screw but a surgeon knows the dimension of the screws used and how to manipulate the screws. There is no artificial intelligence that can perform such critical tasks. Surgeons need to understand and embrace the advanced technology and not be intimated by the medical robots.


Some of the highly popular robots in the orthopaedic devices market

The most popular robots used during spinal surgery include the passive robots. These machines help the surgeon position himself properly in the three-dimensional space. Next, are the advanced active robots as well as the semi-active medical robots. These devices not only help the doctors put in the screws, but also create the decompressions for the surgeons. Doctors usually design the preoperative plan either on an MRI or a CT scan.

Another robot that has caught the attention of many surgeons is one that can mimic activities. This means a doctor who is sitting remotely can operate with a console, while the robot stationed at the patient’s bedside performs the surgery. There is also the parallel manipulator, which offers a 6 degree of freedom platform and moves easily in a three-dimensional space, helping surgeons to position themselves during surgery. Robotic system components popular with spinal surgeons include preoperative planning software, c-arm image adaptor, workstation with touchscreen monitor and surgical accessories.

Other components that are usually attached to a patient during a surgery are mounth frame, spinous process clamp and the hover T frame. During robotic surgery the rate of a misplaced screw is negligible. Besides this, the duration of intraoperative exposure is found to be significantly lower, while the procedure time remains same. Operating with medical robots ensures an enhanced performance in spinal surgery over several free hand surgeries, the malposition rate with robots is just 1 per cent.


Limitation of robotic spinal surgery

Doctors refrain from performing robotic surgery on a patient with extremely poor bone quality. Patients with severe deformity often fail to undergo robotic surgery. At times loosened hardware as well as difficulty with the platform mounting device and drill seating equipment hinders the success of a robotic surgery. Manufacturers active in the orthopaedic devices industry are working hard to resolve the technical issues.


Future of robots in the orthopaedic devices market

Scientists are engaged in combining the synergistic technologies to demonstrate something that will be better than what we use today. Interrelation of semi-active as well as active robots will transform the orthopaedic devices market in another five to six years. There will be more automated medical robotic surgeries.



About the author

Bhawna Rath, is a senior content writer with Allied Market Research. She has worked closely with industry experts from various sectors including chemical, information technology, life sciences, construction and manufacturing. Bhawna’s article focuses mainly on balancing relevant data but never at the expense of making the content engaging. She believes in providing unbiased information to guide major business decisions.