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Combinatorial Technologies Leveraging Robotics in Spine Surgery

Introduction Technological innovations over the past several decades have enabled spine surgeons to steadily increase the safety and efficacy of procedures performed with a focus on improving outcomes, while minimizing the surgical footprint. Innovations in microscopic and endoscopic visualization systems, screw and rod instrumentation, expandable and 3D printed interbody cages, and three-dimensional computer assisted navigation capabilities are among these advancements. Robotic surgery has been revolutionized by…

Databases, Study Groups, and Evidence in Robotic Spine Surgery

Introduction A large amount of literature related to spine surgery is plagued by retrospective design and small sample sizes resulting in a lack of statistical power. This is particularly true for literature regarding the validation of cutting-edge technologies, including robotic guidance systems. The methods by which researchers have attempted to provide studies of a higher yield than small institutional case series and cohort studies include the…

Artificial Intelligence and Machine Learning in Spine Surgery

Introduction of Technology While investigations into incorporating machine learning (ML) and artificial intelligence (AI) into medicine have been numerous and diverse, their aggregate contributions have altered and revolutionized clinical practice. Fundamentally, ML and AI approaches seek to leverage automata for pattern recognition and extrapolation. Generally, approaches are classified as one of two predominant forms: supervised and unsupervised learning. Supervised learning describes those approaches that use a…

Use of Activity Monitors in Enhancing Spine Surgery

Introduction of technology Outcome Measurement: Present Practice and Standard of Care How outcomes are determined after spine surgery has shifted from subjective and solely physician-based to patient-centered and patient-reported. The last few decades have seen the development and systematic validation of a wide variety of generic and disease-specific patient-reported outcome measures (PROMs). Those are usually administered to patients in the form of conventional pen-and-pencil or electronic…

Cost-Effectiveness of Robotic and Navigation Systems

Introduction Substantial technological innovation has been made in spine surgery over the last few decades. This innovation has ranged from improvement in operative techniques, surgical implants, and biologics to improved accuracy with image-guided navigation and robotics. Robotic assistance is being increasingly utilized across multiple surgical specialties including urology, obstetrics and gynecology (OB/GYN), orthopedics, and neurosurgery. Although the utilization of robotics in spine surgery is still in…

Traumatic Spinal Injury and Robotic Reconstruction

Introduction of Technology Traumatic spinal injury (TSI) may involve injury to the osseous structures, discoligamentous components, spinal cord, nerve roots of the spinal column, or a combination thereof. TSI can lead to a wide range of medical conditions, from minimal nondisplaced fractures to mechanically unstable fractures with associated neurological compromise. The clinical sequelae of TSI, which can include pain and/or neurological deficit, may result in severe…

Robotics in Spine Surgery: Beyond Pedicle Screw Placement

Intraoperative image-guided (IG) navigation and robotic assistance in spine surgery have traditionally been used to improve pedicle screw placement accuracy, decrease radiation exposure for operating room staff and patients, help surgeon ergonomics, and improve overall surgical outcomes. More recently, however, the application of these technologies has expanded to include the resection of spinal column and intradural tumors, evacuation of infection, revision arthrodesis surgery, and deformity surgery.…

Robotic-Assisted Percutaneous Fixation

Introduction of Technology Present Practice and Standard of Care Pedicle screws have been placed to enhance spinal fusion since at least 1959. In that year, Boucher published a report detailing the placement of screws into the vertebral body via the pedicle with generally excellent fusion results. These early pedicle screws passed from the lamina of the superior level through the pedicle of the inferior level, thus…

Robotic-Assisted Correction of Adult Spinal Deformity

Introduction of technology Adult Spinal Deformity: Present Practice and Standard of Care Adult spinal deformity (ASD) is a heterogeneous condition of typically the elderly patient, which involves misalignment in the sagittal and/or coronal plane. ASD can be asymptomatic or, depending on its type and severity, present with varying degrees of, and oftentimes excruciating, pain and disability typically exceeding the health impact of other chronic diseases, including…

Navigation in Non-Instrumented Spine Surgery

Overview Since its emergence about 25 years ago, significant technological advancements have been made in spinal navigation and computer assisted spine surgery. Most of these advancements and the resulting wider spread adoption of the technology have occurred only more recently within the last decade. Some of the reasons for the delayed adoption of the technology in the spine despite early progress with intracranial navigation may relate…

Navigated Oblique Lumbar Interbody Fusion

Background Present Practice There are several well-described approaches for interbody fusion, and these include posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), lateral lumbar interbody fusion (LLIF), and anterior lumbar interbody fusion (ALIF). More recently, the oblique lumbar interbody fusion (OLIF) has been added to the surgeon’s armamentarium ( Fig. 6.1 ). There are advantages of the OLIF over other interbody techniques, but there…

Navigation of Tumor and Metastatic Lesions in the Thoracolumbar Spine

Introduction of Technology Spine oncology is a broad field encompassing a wide array of pathologies. The vast majority are spinal metastases arising from the vertebral body, most commonly in the thoracic (70%) or lumbar spine (30%), secondary to breast, prostate, lung, and renal cell cancers. The patients with these pathologies are often extremely frail and benefit from more minimally invasive approaches. Over the past 5 years,…

Navigated Spinal Deformity Correction

Introduction of Technology: Adult Spinal Deformity Background of Adult Spinal Deformity Adult spinal deformity (ASD) is defined as an abnormal curvature or abnormal alignment of the vertebral column. ASD has been demonstrated to limit a patient’s quality of life significantly, and patients with both cervical and thoracolumbar deformity have predictable declines in health-related quality of life (HRQOL). In the most severe cases, patients with lumbar scoliosis…

Navigation in Spine Trauma

Introduction of Technology Practice and Standard of Care We are in a technological era where advancements in image-guided systems, robotics, machine learning/neuromodulation, and state-of-the-art image-guided operating suites are creating new possibilities in operative neurosurgery. This is resulting in numerous changes and improvements with respect to patient experience, care, and outcomes. Spine surgery is uniquely affected given its heavy reliance on intraoperative devices, biologics, and imaging. Novel…

Navigation in Occipital and Cervical Spine Surgery

Introduction of Technology In the occipital and cervical spine, posterior cervical instrumentation is a commonly selected procedure for stabilization in trauma, neoplasia, deformity, and spondylosis. The earliest techniques described wiring between the spinous processes to achieve bony arthrodesis. Several types of instrumentation systems and screws were subsequently developed, including compression clamps, hook-rod systems, and eventually pedicle screws. Roy-Camille et al. initially proposed the lateral mass screw…

Computer-Assisted Spine Surgery—A New Era of Innovation

The idea of surgical intelligence is finally coming to fruition. The use of both computer and robotic assistance, and increasing use of the two together, has already demonstrated the promise of surgical intelligence to transform spine surgery. Offering potential improvements in surgical accuracy, reductions in postoperative complications, and decreased revision surgeries, computer assistance provides the novel ability to base decision-making support on hundreds of thousands of…