Manual spine stabilisation surgery is one of the most frequent neurosurgical procedures performed and numbers are rising with an ageing population that needs surgical procedures to address degenerative spine disease. The challenge of manual spine surgery with pedicle screws to fuse and stabilise functionally unstable vertebrae is the “uneven terrain” of vertebral bone. The functional articulation of the human vertebral spine that confers lateral and rotational mobility, static stability and compressional strength is only possible because vertebrae have a complex shape and bone density composition. Drilling and positioning a screw into a highly variable part of the spine, whether manually or with image guidance technologies fails to be a success around 15% of the time. The screw misses the central part of the vertebrae and the sharp tip sticks out, in many cases to irritate surrounding tissue or nerves. Revision surgery is unavoidable and the burden to healthcare delivery systems is significant.
The IGT group in collaboration with the neurosurgery team at the Inselspital and the Swiss Center for Electronics and Microtechnology is investigating sensor-enabled surgical robotic drilling technology that turns the variability of the vertebrae from a surgical challenge into the basis of precision surgical procedures. By using the complexity of vertebral anatomy like a “sensor map” the robotic drill is able to “feel” across the bone terrain and together with electromyography neuromonitoring to avoid obstacles including nerves and boundaries of the bone. Thicker bone, thinner bone and nerves are sensed with super-human, robotic perception and verified at high speed with the relevant information from the pre-operative imaging that was established before the procedure. This way the surgical robotic technology potentially allows the neurosurgeon to place pedicle screws perfectly and with precision in every patient, every time.
The aim of this BRIDGE Discovery project is to introduce this augmented, robotic technology into the clinic and begin the process of clinical adoption of the next generation of neurosurgical interventions.