Robotics in Spine Surgery: Beyond Pedicle Screw Placement

Over the past two decades, image guidance and robotic systems have seen a dramatic increase in their utilization worldwide and are becoming important intraoperative adjuncts in spine surgery. The adoption of first navigation and now robotic technology has been gradual and was initially limited to assistance in the placement of pedicle screws. However, recent advances have expanded their application to include the resection of spinal tumors, revision surgeries, and complex deformity surgery. In this chapter, we present two cases demonstrating the advanced use of navigation/robotics and describe the pearls and pitfalls of each case. The first case demonstrates the use of robotics to place a unique screw trajectory and the second illustrates navigated assistance for performing a corpectomy for spinal tumor. This chapter also describes recent developments, limitations, and future prospects in navigation and robotic spine surgery. Although the learning curve is steep, and the cost of navigation and robotic systems is high, experienced groups have demonstrated improved clinical outcomes and workflow advantages of these technologies. Image guidance and robotic spine surgery will continue to evolve, and spine surgeons will be expected to adapt to and work side-by-side with these evolving technologies to improve surgical efficiency and patient outcomes.