Future Growth in Navigated and Robotic Spinal Surgery

As technology advances at a rapid pace, contemporary surgery is becoming more efficacious, precise, and safe, with new options offering promise for some of the most challenging diseases. In this chapter, the authors review several emerging technologies in navigated and robotic spinal surgery, discuss legal questions, and outline future challenges for an evolving field. Augmented reality, including modern heads-up displays such as Google Glass and Microsoft HoloLens, is first reviewed, along with recent systems able to superimpose 3D anatomy with the surgeon's hand and instrumentation. Advances in imaging, including diffusion tensor imaging, are then explored, and potential utilities in tumor resection are discussed. Progress in nanotechnology is covered next, including nanoknife and nanoscaffolds, as well as nanorobots designed to selectively target tumor cells and administer a chemotherapy payload. Legal questions are then investigated, including Food and Drug Administration (FDA) approval and legal liability for robots. The chapter concludes with a discussion of ongoing challenges in robotic spine surgery, including cost-effectiveness, miniaturization, artificial intelligence, and ethical considerations of the robot as a surgeon.