First spine surgery utilizing real-time image-guided robotic assistance

Abstract

Robotics in spinal surgery has significant potential benefits for both surgeons and patients, including reduced surgeon fatigue, improved screw accuracy, decreased radiation exposure, greater options for minimally invasive surgery, and less time required to train residents on techniques that can have steep learning curves. However, previous robotic systems have several drawbacks, which are addressed by the innovative ExcelsiusGPS^TM robotic system. The robot is secured to the operating room floor, not the patient. It has a rigid external arm that facilitates direct transpedicular drilling and screw placement, without requiring K-wires. In addition, the ExcelsisuGPS^TM has integrated neuronavigation, not present in other systems. It also has surveillance marker that immediately alerts the surgeon in the event of loss of registration, and a lateral force meter to alert the surgeon in the event of skiving. Here, we present the first spinal surgery performed with the assistance of this newly approved robot. The surgery was performed with excellent screw placement, minimal radiation exposure to the patient and surgeon, and the patient had a favorable outcome. We report the first operative case with the ExcelsisuGPS^TM, and the first spine surgery utilizing real-time image-guided robotic assistance.

Keywords:

• spine
• robot-assisted
• robotics
• registration
• pedicle screws
• neurosurgery
• neuronavigation
• navigation
• image guided surgery
• intraoperative imaging

Disclosure statement

Dr. Theodore is an inventor of a device manufactured by Globus Medical, Inc., which was used in the study discussed in this publication. He is entitled to royalty payments on future sales of the device and he is a paid consultant to Globus Medical, Inc. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Neil Crawford currently owns stock, receives royalties and is employed by Globus Medical, Inc. Corinna C. Zygourakis, MD: received travel grants to attend resident education course from Globus, Nuvasive, Depuy, and Medtronic. She is supported by an AO Spine fellowship grant. Camilo A. Molina, MD: Consultant for Augmedics.