Elyse Watkins DHSc, PA-C, DFAAPA
The purpose of this clinical review is to illuminate the potential value implementation of robotics in spinal fusion surgery could provide in regard to accuracy, operative duration (OD), radiation exposure (RE), complication rates (CR), and length of recovery (LoR) for patients when compared to the open free-hand (FH) technique utilized in the past with thoraco-lumbar instrumentation procedures.
A PubMed literature search as well as Scholar Google search was conducted with search terms “robotic spine surgery”, “navigation and spinal surgery”, “robotic spine”, “robotic spinal surgery and outcomes”, “minimally invasive spine and robotics”, and “physician assistant and spine robotics”. The term physician assistant was used as the official name change to physician associate for the profession in the United States was voted upon after research completion. All searches were restricted to articles published from 2016-current and only full text articles were considered for use for this clinical review. Those with repetition of referenced previous literature were removed to avoid duplicate use. Original randomized controlled trials (RCT) or cohort studies (CS) were also included as they contained some of the original data and research for which this review would be based upon.
All acquired research suggests that while RE times, LoR, and CRs can be minimized switching from FH technique to robotics; however, accuracy and OD is dependent upon the comfortability of the surgeon for its use. Differences on OD and RE between those procedures using intraoperative navigation platforms versus robotics was insignificant. No studies have been found to address the role of the physician associate (PA) as a first assist and whether they will still be required intraoperatively if robot-assisted fusions become a mainstay of surgical intervention on the spine.
Compared to the open FH technique, implementation of robotics in the thoraco-lumbar fusion procedure has the potential to improve OD, accuracy, CR, and LoR for patients. The cost of purchasing robotic navigation equipment and the learning curve for becoming adequately trained in its use can limit facilities incorporating this into their procedural routine. However, hospitals need to weigh the initial cost and training for use with its long-term benefits; and surgeons need to decipher if robotics provides any additional benefit to using intraoperative navigation systems alone when deciding to transition off the FH technique. This can only be done with more research on specific models in order to decipher what model best suits these procedures. Medical training programs also need to consider how spinals surgeons need to be trained if robotic-assisted spinal surgery becomes the preferred technique in the future. Furthermore, while specialty PAs currently play a role as a first assist in spinal procedures, there will be a need moving forward to establish their potential role intraoperatively as more practitioners transition to this technique.
Keywords: robotic spine, minimally invasive spine, robotic spine and outcomes, physician assistant and spine, physician associate and spine, thoraco-lumbar fusion, spinal instrumentation
Garcia AM. The Implementation of Robotics in Thoraco-Lumbar Spinal Surgery to Improve Patient Outcomes. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(3).
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