Navigation and robot-aided surgery in the spine: historical review and state of the art

Abstract

Spinal anatomy is complex and in close vicinity of vulnerable anatomical structures, such as nerve roots, spinal cord, and blood vessels, requiring high precision in surgical procedures, while the surgical exposure is limited and even more limited in percutaneous procedures. A high risk of misplaced implants and/or high intraoperative radiation exposure are the consequences. Spinal navigation techniques have been introduced to alleviate these problems. The majority of reports on navigation document its role in increasing implant-placement accuracy and reduc- ing intraoperative radiation. The technology is increasingly finding acceptance amongst spinal surgeons. This however does not yet present the end of the road. Robotic applications could be regarded as a coherent continuation of spinal navigation. We reviewed the literature pertaining to spinal navigation, as well as novel and upcoming robotic applications for spinal surgery. For this purpose, a Medline search using the terms robot and spine and extensive cross-reference analysis (using Medline, Ovid, and Web of Science data banks) were performed. The goal was to provide an overview of present achievements and novel developments in this fast-growing research area. While a number of robotic techniques are under investigation, mainly to aid navigated screw placement, the SpineAssist/Renaissance system has cleared US Food and Drug Administration approval and is in relatively wide clinical use. Another robotic system, the da Vinci, is currently applied in an increasing number of cases under research protocols.