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当代脊柱机器人技术面临的挑战:鼓励脊柱外科医生推动未来机器人平台发展的变革性变化。

Challenges in contemporary spinal robotics: encouraging spine surgeons to drive transformative changes in the development of future robotic platforms.

作者信息

Malham Gregory M, Wells-Quinn Thomas A, Nowitzke Adrian M, Mobbs Ralph J, Sekhon Lali H

机构信息

Neuroscience Institute, Epworth Hospital, Melbourne, VIC, Australia.

Spine Surgery Research Foundation, Richmond, VIC, Australia.

出版信息

J Spine Surg. 2024 Sep 23;10(3):540-547. doi: 10.21037/jss-24-4. Epub 2024 Jul 5.

DOI:10.21037/jss-24-4
PMID:39399084
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11467282/
Abstract

The field of spinal robotics has witnessed considerable advances, which have primarily focused on enhancing pedicle screw placement. This article critically evaluates the current direction of spinal robotics development, raising concerns about the disproportionate emphasis on pedicle screw placement when existing techniques already yield commendable results. Discussions on various parameters, including quality, cost-effectiveness, and accessibility, highlight the need for a broader perspective in the development of robotics for spinal surgery. Comparative analyses reveal that navigation systems offer cost-effective and time-efficient alternatives to robotics, with similar accuracy levels. Patient demand for robotic interventions is influenced by perceived superiority, warranting careful consideration of public sentiment. This article also underscores the need for future spine surgeons to maintain proficiency in traditional techniques. The influence of industry and key opinion leaders in steering the focus toward pedicle screw placement is discussed, emphasizing the need for a more holistic approach. Accessibility issues and legal considerations in the evolving field of spinal robotics are addressed, and the potential for robotics to enhance various aspects of surgical procedures beyond pedicle screw placement is explored. In conclusion, we advocate for a shift in focus in spinal robotics, emphasizing the untapped potential to streamline common surgical procedures (such as discectomy, laminectomy, and endoscopy), enhance precision, and improve patient outcomes in areas beyond pedicle screw placement. Future advances in spinal robotics have the potential to transform the surgical landscape, benefitting all stakeholders, including patients, surgeons, and hospitals.

摘要

脊柱机器人领域已经取得了显著进展,这些进展主要集中在提高椎弓根螺钉置入方面。本文批判性地评估了脊柱机器人技术发展的当前方向,对现有技术已经取得可观成果的情况下仍过度强调椎弓根螺钉置入提出了担忧。对包括质量、成本效益和可及性在内的各种参数的讨论,凸显了脊柱手术机器人开发需要更广阔视角的必要性。比较分析表明,导航系统为机器人技术提供了具有成本效益且高效省时的替代方案,其精度水平相近。患者对机器人干预的需求受感知到的优越性影响,这就需要认真考虑公众情绪。本文还强调了未来脊柱外科医生保持传统技术熟练程度的必要性。文中讨论了行业和关键意见领袖在引导关注方向至椎弓根螺钉置入方面的影响,强调需要采取更全面的方法。探讨了脊柱机器人技术不断发展领域中的可及性问题和法律考量,并探索了机器人技术在椎弓根螺钉置入之外增强手术操作各个方面的潜力。总之,我们主张脊柱机器人技术的重点应有所转移,强调在简化常见手术程序(如椎间盘切除术、椎板切除术和内窥镜检查)、提高精准度以及改善椎弓根螺钉置入之外领域的患者预后等方面尚未开发的潜力。脊柱机器人技术的未来进展有可能改变手术格局,使包括患者、外科医生和医院在内的所有利益相关者受益。

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Robot-assisted spinal augmentation procedures: is it worth the increased effort?机器人辅助脊柱增强手术:是否值得付出更多努力?
Eur Spine J. 2023 Nov;32(11):3927-3932. doi: 10.1007/s00586-023-07735-z. Epub 2023 Jun 13.
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Robotic navigation during spine surgery: an update of literature.脊柱手术中的机器人导航:文献更新。
Expert Rev Med Devices. 2023 Jun;20(6):427-432. doi: 10.1080/17434440.2023.2200932. Epub 2023 Apr 12.
3
Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws: a systematic review and meta-analysis.
机器人辅助和导航椎弓根螺钉比透视下徒手置入螺钉更安全、更精确:一项系统评价和荟萃分析。
Spine J. 2023 Feb;23(2):197-208. doi: 10.1016/j.spinee.2022.10.006. Epub 2022 Oct 21.
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Negotiating for new technologies: guidelines for the procurement of assistive technologies in spinal surgery: a narrative review.新技术谈判:脊柱手术辅助技术采购指南:一项叙述性综述
J Spine Surg. 2022 Jun;8(2):254-265. doi: 10.21037/jss-21-107.
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Robotic Spine Surgery: Past, Present, and Future.机器人脊柱外科:过去、现在与未来。
Spine (Phila Pa 1976). 2022 Jul 1;47(13):909-921. doi: 10.1097/BRS.0000000000004357. Epub 2022 Apr 21.
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Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula.机器人辅助脊柱手术的学习曲线:系统评价及对住院医师培训课程应用的建议。
Neurosurg Focus. 2022 Jan;52(1):E3. doi: 10.3171/2021.10.FOCUS21496.
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