Pushing the Boundaries of a New Era in Robotic Spine Surgery

Over the past 15 years, advances in navigation and robotic technologies have further transformed the field of spinal surgery. More specifically, minimally invasive spine surgeries are now made possible with significantly less radiation and increasing accuracy and safety. Through its team of highly skilled surgeons and researchers, the Department of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai continues to push the envelope of minimally invasive surgery, preparing the field for increasingly complex hardware placement, tumor resections, and osteotomies supported by three-dimensional navigated guidance that is visible to the entire surgical team.

“By incorporating sophisticated image guidance and robotics, we are able to expand our indications and do more complicated surgeries such as deformity correction through less invasive means,” says Saad B. Chaudhary, MD, Associate Professor of Orthopedic Surgery at Icahn Mount Sinai. “As an academic institution, our goal at Mount Sinai is to use technology to deliver less-invasive spine surgery to patients in the safest, most reproducible, and reliable way. I think you will see more widespread adoption of these technologies as they become more refined and surgeons beyond the major medical centers are gaining comfort and experience with them.”

An Unmatched Improvement in Accuracy

Dr. Chaudhary—who performs nearly 300 surgeries a year, many of them using cutting-edge technologies and techniques—underscores the importance of accuracy. Open surgery using freehand hardware placement is still the most dominant practice. While this is a safe-and-effective technique, there can be risks of screw malposition or complications (2 to 20 percent). The accuracy rate of hardware placement improves when two-dimensional fluoroscopy is used in the operating suite, but tremendously shoots up to 95 to 98 percent with the use of real-time navigation and robotic technologies.

Another member of the spine surgery team at Icahn Mount Sinai, Wesley H. Bronson, MD, Assistant Professor of Orthopedic Surgery, aims to completely convert his practice to use minimally invasive techniques.

“With improved technology and the ability to intraoperatively create 3D models of the spine in real time, we can now accurately place not just screws but other types of hardware—such as spinal cages—through smaller incisions,” he explains. “The ability to navigate a probe or instruments into a disc space further streamlines the process and cuts time from the operation by allowing us to know exactly where that instrument or cage is being placed.”

Refining the Surgical Process without Reducing Physician Oversight

The incentives to expand use of robotics and navigation in spine surgery are inextricably linked to the benefits that accrue to both patients and physicians. They include less blood loss and damage to collateral tissue, resulting in quicker recovery and discharge from the hospital by the patient. And the integration of robotic techniques to guide the surgeon’s miniaturized tools, along with advanced navigation to provide real-time visual verification, helps to raise accuracy and patient outcomes to new levels.

For patients and physicians, minimally invasive spine surgery can result in shorter procedures and quicker recovery. An even greater benefit, though, is the reduction in potentially harmful radiation exposure from the repetitive need for fluoroscopic imaging guidance when traditional surgical techniques are employed. This exposure over the course of scores or hundreds of surgeries poses a real threat of cancers and cataracts to not just surgeons, but the entire operating room team.

Despite the renaissance in robotic surgery of recent years, Dr. Chaudhary emphasizes the continued need for “human touch and human oversight” of the process.

He adds: “Robotics is not so much a replacement but an enhancement of the surgeon’s skills and capabilities. We need to be aware at all times of the pitfalls as well as the opportunities the technology provides.”

"Understanding the complex spinal anatomy and executing open spinal surgeries safely is critical to performing less-invasive studies with navigation and robotic platforms," says Dr. Chaudhary. "Those of us who are dedicated to providing excellent patient care while training the next generation of spine surgeons must continue to incorporate and enhance technologies to our practice for the betterment of patient outcomes."

The team continues to strike the balance between the human art and craft of spine surgery with automation and robotic delivery of surgical techniques with the goal of standardizing the delivery of spinal care that yields excellent and reliable patient outcomes.