Robotic spine surgery: a review of the present status.

With technological advancements being introduced and dominating many fields, spine surgery is no exception. In view of the patient safety and surgeon's comfort, robotics has been introduced in spine surgery. Due to small corridors for work, little room for inaccuracy, lengthy and tedious procedures, spine surgery is an ideal scenario for robotics to establish as the standard of care. Spine robotics received their first FDA clearance in 2004. New generation of spine robotics with integrated navigation systems has become available now. The primary role of spine robotics, at present, is to aid pedicle screw fixation. High quality studies have been performed to establish its role in increasing the accuracy of pedicle fixation. Studies have also reported decreased radiation and decreased operative time with spine robotics. However, few studies have reported otherwise. It is still in its nascent stage in both industrial view and surgeon familiarity. Continued research to overcome the challenges such as high cost and steep learning curve is crucial for its widespread use. Also, expanding the scope of spine robotics beyond pedicle screw fixation such as osteotomies and dural procedures would be an area for potential research. This review is intended to provide an overview of various studies in the field of robotic spine surgery and its present status.

Sympathetic Outflow Disturbance After Posterior Deformity Correction: A Rare Complication.

INTRODUCTION: Sympathetic system injury is a known but rare complication in scoliosis deformity correction. It is not common following posterior correction. We report a case of diastematomyelia with neuromuscular scoliosis with unusual complication of sympathetic outflow disturbance, after posterior instrumented correction. CASE DESCRIPTION: A 13-year-old girl presented with complaints of deformity in the back first noticed 4 years ago. Roentgenogram revealed a right thoracolumbar kyphoscoliotic deformity of 105° with apex at T8 with non-structural lumbar and cervicothoracic curves with positive sagittal alignment. Magnetic resonance imaging showed split-cord malformation with bony crest near the apex of the curve. Detethering followed by removal of the bony crest and restoration of the dual dural sleeves of the split cord into single neural tube was done in the first stage. In the second stage, pedicle screw fixation with was done from D3 to L3. Deformity correction was achieved using multilevel Smith Peterson osteotomy and concave rib osteotomy. On the second postoperative day, intensive care unit staff noticed persistent sinus tachycardia and profuse sweating in both upper limbs, chest, and upper-back. Twenty-four-hour Holter monitoring did not reveal any abnormality. Patient improved gradually and was discharged on postoperative day 9 when both sinus tachycardia and hyperhidrosis resolved. CONCLUSIONS: Sympathetic chain disturbances after surgery recover with time. The exact time duration needed for recovery is not yet defined, however. Spine surgeons should be aware of this postsurgical complication and identify it so that management can be initiated. The symptoms may be long and drawn out, thus the roles of communication with and counseling of the patient as cannot be underemphasized.