Information Technology Reference
In-Depth Information
Robotic Assistance and Intervention
in Spine Surgery
Rajesh Kumar
Abstract
Robotic assistance and intervention methods have now been in use in
several surgical specialties for nearly three decades. While image guided surgery for
orthopedics (led by such developments as the Integrated Surgical Systems Inc.
ROBODOC system) lead early clinical application, it is laparoscopic and telesur-
gical robotic applications (such as with the Intuitive Surgical Inc. da Vinci surgical
systems) that have found the widest clinical and user acceptance. Orthopedic and
neurosurgical robotic systems have yet to be widely applied as robotic assistance
systems (such as Mazor Robotics SpineAssist or Renaissance systems) have only
been recently approved for clinical use. Given the large volume of spinal proce-
dures such as pedicle screw placement for spinal fusion, vertebroplasties, osteot-
omies, biopsies and other spinal surgeries several other image-guided robotic
systems are in advanced research and development. The goals of these devices
include improving the ef
cacy and safety (including radiation safety) for both the
patient and the surgeon. This survey includes recent development and results for
these robotic applications.
1 Overview
Preoperative
fluoroscopic imaging is commonly used to plan orthopedic surgeries
as well as for enabling robotic [
1
] spine applications (Fig.
1
). Targets in hard
anatomy are typically immobilized, and imaged using commonly accessible
fl
fl
uo-
roscopy (CT, Biplanar or C-Arm) imaging. Fiducials with unique
fluoroscopic
signature attached to the device or anatomy are used to aid registration as well.
For intra-operative guidance or robotic automation, accurate registration to
anatomy is the most important procedure step, while safety and ef
fl
cacy are the
most important factors from the patient perspective.
