Robots in Spine Surgery

Robotic technology is revolutionizing various aspects of medicine, and spine surgery is no exception. By integrating robotics into surgical procedures, neurosurgeons and spine specialists can achieve unprecedented levels of precision, efficiency, and safety. This blog will explore the types of surgical robots, prominent robotic systems in spine surgery, and their features and benefits.

Types of Surgical Robots

Surgical robots can be classified into three categories based on the degree of control and interaction with surgeons:

1. Supervisory-Controlled Robots: These robots perform pre-programmed tasks under the supervision of a surgeon. Example: Cuvis.

2. Tele-Surgical Robots: These systems allow surgeons to operate remotely using robotic arms. Example: Da Vinci Surgical System.

3. Shared-Controlled Robots: In this approach, robots and surgeons work collaboratively, enhancing precision while maintaining surgical flexibility. Example: Spine surgery robots.

Prominent Spine Surgery Robots

1. MazorX Stealth Edition (Medtronic): A cutting-edge robotic system designed for spinal surgeries, the MazorX system integrates imaging and navigation to ensure precise placement of implants.

   

   

   Key Components of the MazorX System

   The MazorX system is composed of several advanced parts, each designed to fulfill a specific role in ensuring surgical precision and efficiency:

   1. Robot Shoulder and Surgical Arm

      • The robot shoulder supports the surgical arm, enabling fine-tuned movements and control.

        

      • The surgical arm positions instruments or screws with sub-millimeter accuracy, guided by preoperative planning and intraoperative imaging.

        

   2. Emergency Stop Button

      • Provides a critical safety mechanism to halt the robot's operation instantly if necessary.

      • Ensures surgeon control at all times during the procedure.

   3. Arm Guide

      • Acts as a stabilizing mechanism, guiding surgical tools to the exact target location based on navigational inputs.

      • Reduces manual variability, enhancing precision during implant placement.

        

   4. Navigation Camera

      • Tracks the markers and arrays to provide real-time 3D visualization using principle of triangulation.

      • Synchronizes with preoperative plans to ensure accurate alignment and orientation.

        

   5. Passive Marker-Spheres

      • Reflective markers used for tracking the spatial position of the robot in relation to the patient.

      • These markers are integral to maintaining accurate navigation throughout the procedure.

        

   6. Manipulator and Surgical System

      • The core robotic unit, responsible for carrying out planned surgical trajectories.

      • Operates in an extended (launched) position during surgery and retracts for storage.

        

      

   7. Reference Arrays

      • Reference arrays are fixed to the patient's anatomy to create a coordinate system for navigation.

      • These arrays are critical for maintaining consistent alignment and tracking during surgery.

        

   8. Snapshot Tracker

      • Captures intraoperative robotic arm position and calibrates them with preoperative plans.

      • Enhances the precision of dynamic adjustments during surgery.

        

   9. NavLock System

      • Facilitates secure and accurate attachment of surgical instruments.

      • Ensures stability during critical steps of the procedure.

        

   10. Robotic Kit for CT-Fluoro Workflow

       • Includes sterile drapes, fiducial arrays (e.g., star markers), and other accessories.

       • Supports preoperative imaging, intraoperative navigation, and post-surgical verification.

   11. Fiducial Array (Star Marker)

       • Serves as a critical reference point for imaging and navigation.

       • Enables seamless integration of CT and fluoroscopic data into the surgical workflow.

         

   12. Navigation Camera: Enhances real-time accuracy during surgery.

   13. Emergency Stop Button: Ensures safety in critical scenarios.

   14. Passive Marker-Spheres and Reference Arrays: Enables precise spatial referencing.

   The MazorX allows a seamless "Scan & Plan" workflow and CT fluoro Workflow allowing multiple options for different setups.

   
   

2. ExcelsiusGPS (Globus Medical): Known for its integration of navigation and robotic assistance, this system supports minimally invasive procedures and reduces operating times.

   

3. Rosa One Spine (Zimmer Biomet): The Rosa system excels in complex spine procedures, combining robotic precision with advanced imaging.

   

4. Curexo (Cuvis Spine): A versatile robot for various spine surgeries, the Curexo system supports supervisory-controlled workflows, ensuring consistent results.

   

5. Cirq (Brainlab): This compact robotic system emphasizes simplicity and versatility, ideal for hospitals with space constraints.

   

6. TiNavi (China): An emerging robotic platform that demonstrates promising potential for minimally invasive spine surgeries.

   

Advantages of Robotic Spine Surgery

• Precision: Robotic systems allow for sub-millimeter accuracy in implant placement, reducing risks of complications.

• Minimally Invasive Procedures: Smaller incisions lead to reduced blood loss, faster recovery, and lower infection risks.

• Enhanced Visualization: Integration of imaging technology ensures real-time feedback for surgeons.

• Consistency: Robots eliminate variability, maintaining high standards of care across surgeries.

• Reduced Radiation Exposure: Preoperative planning and precise navigation minimize fluoroscopic dependency.

Clinical Workflow: MazorX Example

The MazorX Stealth Edition highlights the workflow enhancements robotics bring to spine surgery:

1. Preoperative Phase:

   • CT-based planning with fiducial markers ensures precise mapping.

   • Surgical kits and drapes maintain sterility.

2. Intraoperative Phase:

   • The system utilizes a "Scan & Plan" approach for real-time adjustments.

   • Navigation cameras and star markers guide the surgical arm.

3. Postoperative Phase:

   • High accuracy reduces revision surgery rates, promoting better patient outcomes.

Challenges and Future Prospects

While robotics in spine surgery is transformative, certain challenges persist:

• Cost: High initial investments may limit accessibility.

• Learning Curve: Surgeons require specialized training to maximize robotic potential.

• Technological Limitations: Innovations in AI and machine learning could further optimize robotics.

Looking ahead, advancements in artificial intelligence, augmented reality, and telemedicine are expected to amplify the utility of robotic systems in spine surgery, paving the way for enhanced precision and patient care.