The History of Robotics in Spine Surgery

摘要

Robotic surgical systems have been utilized in many surgical fields, including gynecology, urology, cardiothoracic surgery, vascular surgery, and general surgery.1–3 Robotic-assisted systems in spinal surgery, however, have only become available relatively recently. The evolution of robotics in spinal surgery parallels the evolution of image guidance. In 1908, Victor Horsley and Robert Clarke first coined the term “stereotaxis” to define a neurosurgery method utilizing the Cartesian coordinate system to locate points within the brain using external cranial landmarks.4 Modern stereotaxic integration with computed tomography arrived in 1986, developed by David Roberts.5 Moreover, Food and Drug Administration (FDA) clearance of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) for general laparoscopic surgery in 2000 marked a new era for robotic-assisted surgery, with four arms and seven degrees of freedom. The first robotic-assisted system for spinal surgery, SpineAssist, (Mazor Robotics Ltd., Casesarea, Israel) received FDA clearance in 2004, and demonstrated an average error of less than 2 mm in 98.3% of pedicle screws inserted (N = 646).6 In a study comparing freehand fluoroscopy-guided screws to robotic assisted thoracolumbar pedicle screws, SpineAssist had a significantly greater proportion of non-misplaced screws in comparison to freehand (Gertzbein-Robbins Grades A and B; P = 0.005).7 In a study of 20 open robotic-guided and 57 open conventionally placed screws, SpineAssist's successor, the Renaissance Guidance System (Mazor Robotics Ltd.), demonstrated 94.5% accuracy versus 91.4% accuracy with conventionally placed screws.8 ExelsiusGPS™ (Globus Medical Inc., Audubon, PA), which was granted FDA clearance in 2017, has the potential to revolutionize the field of robotic-assisted spinal surgery. With automated accuracy, reproducible outcomes, efficient integration, automatic patient registration, constrained motion for safety, and automatic compensation for patient movement, ExelsiusGPS™ addresses many of the drawbacks of previous robotic-assisted systems. The future of robotic-assisted spinal surgery is promising, offering less time required to train residents in pedicle screw insertion, greater accuracy compared with freehand, a more minimally invasive approach, and reduced radiation exposure in comparison to intraoperative fluoroscopy.