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Adler: Commentary on “Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article”
The integration of surgical navigation, robotics, augmented reality, and virtual reality is rapidly transforming the landscape of spine surgery and driving many advancements in the field of minimally invasive spinal surgery. The present review article encapsulates the pivotal role these innovations are starting to play in the precision, efficiency and even feasibility of both new and older spinal procedures. Most tangibly these technologies enable marked improvements in the accuracy of pedicle screw placement while reducing radiation exposure, and accelerating learning curve for young neurosurgeons.
Importantly, this review emphasizes the nascent stage of research concerning both the clinical outcomes and cost-effectiveness of navigation and robot-assisted spinal surgeries. Although the lack of unambiguous real-world evidence complicates the task of assessing their long-term benefits of these technologies, the author of this review article attempts to mitigate this shortcoming by simply providing an up-to-date summary of current spinal navigation and robotic surgery systems [1].
The authors’ review underscores the significant progress achieved by surgical navigation technologies in recent years, highlighting the advantages these methods offer in terms of both enhancing clinical outcomes and expediting surgeons’ learning curves. Nevertheless, the review also laudably draws attention to a crucial hurdle that impedes widespread adoption: cost-effectiveness. Despite undeniable benefits, the economic viability of implementing spinal navigation and robotic methodologies in standard clinical practice remains a pressing concern.
To address this final challenge, the author advocates for future studies that delve beyond clinical efficacy, and instead increasingly focus on the economic implications of robotic spinal surgery systems. Such future research should include training costs, initial investments, maintenance and service fees, as well as ongoing operating expenses. Only through such comprehensive assessments can the feasibility of integrating these advanced platforms into standard clinical practice be ascertained.
While lauding the recent technical progress that has been made in spinal surgery robots, I would be remiss to not remind readers that a practical and highly cost effective autonomous robotic has been performing spinal surgery on patients for 25 years now; I am referring to the CyberKnife Radiosurgical system (Accuray Incorp., Madison, WI, USA) which has been used to operate on more than 100,000 spinal lesions and is currently used daily in the lives of dozens of patients [2].
In conclusion, the review article elucidates the transformative potential of navigation and robotic spinal surgery technologies while highlighting the imperative of conducting rigorous economic evaluations. By scrutinizing both clinical outcomes and financial implications, stakeholders can make informed decisions regarding the integration of these advanced techniques into standard clinical practice, thus ushering in a new era of spinal surgical interventions. While many of the clinical benefits of navigation and robotic spinal surgery systems are undeniable, their long-term sustainability hinges on addressing cost-effectiveness concerns. The increasing inroads of all advanced technologies into spine surgery, some of which even deliver noninvasive therapies (CyberKnife), require surgeons to re-examine the essence of their craft and specialty, and in doing so, redefine what it means to be a surgeon. After all, neurosurgeons of the future are likely to be much more than their steely nerves and a steady hand!


Conflict of Interest

The author has nothing to disclose.


1. Lee YS, Cho DC, Kim KT. Navigation-guided/robot-assisted spinal surgery: a review article. Neurospine 2024;21:8-17.
crossref pdf
2. Adler JR. Remote robotic spine surgery. Neurospine 2020;17:121-2.
crossref pmid pmc pdf

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