Robotic & Navigated Spine Surgery

Spinal implants such as screws must be placed accurately, often close to the spinal cord and nerves and sometimes within anatomy that is distorted by deformity or previous surgery. Robotic and navigated spine surgery use computer guidance — and, in robotic systems, a robotic arm — to help plan and execute that placement with high precision. It is important to be clear from the outset that these are tools that support the surgeon; they do not replace surgical judgement, experience, or the surgeon’s control of the operation.

What it is

Navigation, or image-guided surgery, builds a detailed three-dimensional map of the spine from a patient’s imaging and tracks the surgeon’s instruments against that map in real time, so their exact position relative to the anatomy is visible throughout. Robotic systems add a robotic arm that holds a guide along a trajectory planned in advance, helping the surgeon follow the plan precisely. A related technology — 3D-printed patient-specific guides — uses a patient’s own scans to manufacture a guide that fits their unique bony anatomy and directs drilling or planned osteotomies along the intended path.

Who is a candidate? (Indications)

Robotic, navigated, or guide-assisted techniques may be particularly useful in patients with:

• Complex or severe deformity, where the anatomy is distorted and landmarks are unreliable
• Difficult or abnormal anatomy, including congenital variation or previous surgery
• Planned osteotomies or instrumentation that demand precise, pre-planned trajectories
• Situations where minimally invasive placement of implants is intended

For many routine operations, well-established techniques achieve excellent results without this technology, so its use is decided case by case.

How it is performed

The technology is integrated into an otherwise familiar operation. In broad terms:

1. The surgeon plans implant positions or bone cuts in advance on the patient’s imaging.
2. During surgery, the patient’s anatomy is registered to that imaging so the map is accurate.
3. Navigation tracks the instruments, or a robotic arm aligns a guide, along the planned path.
4. The surgeon places the implants or performs the osteotomy, confirming position as they go.
5. Imaging may be used to verify placement before the operation is completed.

Throughout, the surgeon remains in control, using the technology to support — not replace — their own judgement, and spinal-cord monitoring is used where appropriate.

Technology and its role

The purpose of these tools is to improve the accuracy and consistency of implant placement, especially where the anatomy is challenging, and to help execute a pre-planned strategy faithfully. Their benefit depends on accurate imaging, correct registration of the anatomy, and sound planning; errors in set-up can reduce their value. They add equipment, cost, and some set-up time, and are not available in every centre. They are best understood as aids that help a skilled surgeon deliver a carefully made plan, rather than as a guarantee of any particular result.

Benefits and risks

The potential benefits are more accurate and consistent implant placement, support for complex trajectories, and a faithful execution of detailed pre-operative plans. The limitations and risks include dependence on imaging and correct set-up, added cost and time, limited availability, and the fact that the technology does not remove the underlying risks of spinal surgery — injury to the spinal cord or nerves, bleeding, infection, implant problems, and the possibility of further surgery. These are discussed individually so that the chosen approach genuinely serves the patient.

Alternatives

The principal alternative is conventional, freehand or fluoroscopy-guided surgery performed with established techniques, which remains highly effective in experienced hands for a great many operations. The choice between conventional and technology-assisted approaches depends on the complexity of the anatomy, the operation planned, and what is likely to benefit the individual patient.

Dr. Garg’s approach & experience

Dr. Garg is Principal Director & Head, Orthopaedics & Spine at Max Hospital, Delhi, and a former Professor at AIIMS New Delhi, with more than 325 peer-reviewed publications and seven patents or device innovations. His research includes robotic and navigated spine surgery and the development of 3D-printed patient-specific osteotomy and drill guides, supported by DBT and ICMR research grants for AI and computer-assisted patient-specific guides.

This work extends to artificial-intelligence and machine-learning analysis of deformity, including machine-learning classification of adolescent idiopathic scoliosis from EMG and gait data published in 2022. Together, these strands reflect a research-led interest in how technology can support — within clear limits — the safe and accurate correction of complex spinal deformity.

When to seek a specialist opinion

A specialist assessment is appropriate where spinal surgery is being considered for complex deformity or difficult anatomy, or where you would like to understand whether navigated or robotic techniques might help in your particular case. A specialist can explain what the technology can and cannot offer for your anatomy, and recommend the approach most likely to be of benefit.