Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

Abstract

Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.

Keywords: Augmented reality; Computer-assisted surgery; Navigation; Robotic spine surgery; Telesurgery.

Fig. 1.

The da Vinci telesurgical system (Intuitive Surgical, Sunnyvale, CA, USA). Image courtesy of Intuitive Surgical Inc.

Fig. 2.

Transpedicular screw drilling using the Mazor X (Mazor Robotics Inc., Caesarea, Israel) robotic system.

Fig. 3.

The ExcelsiusGPS (Globus Medical, Inc., Audubon, PA, USA) surgical system allows to guide pedicle screw insertion utilizing a patient-mounted reference array.

Fig. 4.

Cirq (Brainlab, Munich, Germany) robotic arm used for pedicle screw drilling in a case of L5–S1 grade II isthmic spondylolisthesis.

Fig. 5.

The xvision headset (Augmedics, Arlington Heights, IL, USA) utilized to assist percutaneous screw placement in a cadaveric human torso. Written consent has been regularly obtained for publication.