Using robotic-assisted spine surgery to improve outcomes and improve standard of care

As surgical technology advances, spine surgery will become more automated, more precise and much more standardized, providing valuable data for benchmarking and informing standard of care guidelines.

As surgical technology advances, spine surgery will become more automated, more precise and much more standardized, providing valuable data for benchmarking and informing standard of care guidelines.

Ask five surgeons to do an L4-L5 fusion now, and you will get five different approaches. Robotic-assisted surgery has the power to change that.

Robotic platforms can do more than assist with the precise placement of a screw or implants. They can serve as repositories of data. Procedures — and their outcomes — can be benchmarked. Over time, this information has the power to show what standard of care should look like.

I was an early adopter of robotic surgery, and I’ve seen what a difference it can make. In January 2019, I was the first surgeon in the world to use the Mazor X Stealth system. Since then, I’ve done more than 250 cases using the platform and over 350 robotic-assisted cases total at our practice, Norton Leatherman Spine.

Benefits of robotic-assisted spine surgery

The process is straightforward. Prior to robotic-assisted spinal surgery with the Mazor X Stealth system, patients undergo a CT scan. This lets me plan the exact trajectory of the screws I’ll be using during the operation. With the plan in place, the software guides the surgical arm into position during surgery, allowing me to insert the screws at the precise angle to give the best results for the individual patient. With robotic surgery, surgeons can perform minimally invasive surgery much more effectively.

The benefits of this technology in the literature are less instrumentation malposition or screw malposition, less radiation for the patient and for the surgeon and staff — since multiple X-rays or intraoperative CT scans are no longer needed — and improved perioperative recovery kinetics.

I’m so passionate about robotic-assisted surgery that I’ve started a virtual visiting clinician program once or twice a month, livestreaming surgeries for surgeons and others who want to see the technology in action. So far, I’ve trained more than 100 surgeons in eight countries.

Clinical trials and studies, as well as published research, are a priority at Norton Leatherman Spine as we pursue discoveries that advance care and improve outcomes.

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I’m also actively involved in developing the next generation robotic system. I’m chairman of the Medtronic Robotics Advisory Board and, along with some colleagues, have been working with Medtronic on the successor to the Mazor X Stealth platform.

The next generation system also likely will bring artificial intelligence and machine learning to spine surgery. Because of the massive variability within spine surgery currently, this type of data will be enormously useful. Not only can it benchmark an individual surgeon’s approach, showing average alignment and placement of screw, it can benchmark what’s normal across all surgeons, which will show what standard of care should look like.

We’re also gathering robotic surgery data prospectively. I’m on the medical and scientific board of the National Spine Health Foundation, which has received a multimillion-dollar grant to start the first robotics registry in the world. Norton Leatherman Spine Center and five other centers will contribute prospective patients to study the benefits of robotic-assisted spine surgery.

Robotic -assisted systems are a powerful tool to help us deliver better care to many of our patients, but I’m not about to hand over my scalpel to a robot just yet, at least not for every surgery. I’m not in favor of  robotic-assisted approach in all surgeries. We still need to teach our fellows and future spine surgeons how to place screws without assist technology. So I still use a freehand technique in my really complex cases.

Still, I have no doubt robotic-assisted technology is the future, and I’m proud Norton Leatherman Spine is leading the way.

Jeffrey L. Gum, M.D., is an orthopedic spine surgeon with Norton Leatherman Spine. 

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