Surgical robotics technology originated in industrial robots, and from the development of the last two decades, people quickly and more comprehensively find the next application scenario of surgical robots – orthopedics, typically such as internal fixation of the spine, so the spine surgical robot was born.

In terms of workflow, the main technical routes of spine surgery robots can be divided into two types: one is preoperative planning (based on preoperative CT) + intraoperative 2D imaging; the other is intraoperative planning (based directly on intraoperative 3D imaging).

Intraoperative 3D imaging

Robotic spine surgery using 2D imaging requires the use of a 2D C-arm X-ray machine, a physician workstation, navigation and positioning, and a spine surgery robot.

The general process is as follows:

First, a CT scan is performed preoperatively to obtain a 3D image of the patient’s surgical area, and then segmentation and 3D reconstruction are performed to obtain a virtual 3D vertebral body and segment the 3D vertebral image.

Then, the doctor can carry out surgical planning on the 3D vertebral body image to complete preoperative surgical planning; use the C-arm to perform 2D fluoroscopy on the patient’s vertebrae during surgery to obtain 2D images, and match the intraoperative 2D fluoroscopy with the preoperative CT 3D image through the graphic alignment algorithm, which generally requires the completion of the alignment of two 2D X-ray films to the 3D CT image from different angles, so as to achieve preoperative surgical planning Precise alignment with the patient’s surgical position.

The surgery is then completed through real-time navigation tracking, automatic positioning of the robotic arm and execution of the surgical operation (either by the physician’s bare hands or automatically by the robot).

In contrast, the technical route of robotic spine surgery using 3D imaging does not rely on preoperative CT scans; it is performed intraoperatively by scanning the patient’s surgical area with a 3D C-arm or O-arm, completing the alignment of the robotic arm with the patient’s surgical position and the spatial coordinate system of the navigation device, followed by intraoperative surgical planning, execution of robotic arm-assisted positioning through navigation guidance, execution of surgical operations by the surgeon based on positioning and orientation, and verification of the implant position through the The navigation system verifies the position of the implant and thus completes the surgical operation.

It can be seen that the difference between 2D and 3D spine surgery robots is mainly reflected in the complexity of the surgical process and the clarity of the clinical images.

At present, the domestic 3D spine surgery robot is represented by Puai Medical, which is one of the few manufacturers in the industry that has mastered the C-arm intraoperative 3D imaging technology and is the pioneer of the “spine surgery robot + flat 3D C-arm” full process solution in China. The solution adopts integrated adaptive alignment technology, mounting the scale (i.e. calibration target) on the C-arm, and automatically completes the registration and alignment steps without the limitation of image quality by tracking and matching the motion trajectory acquired in real time with the preset trajectory. The advantage is high clinical accuracy up to sub-millimeter (0.7mm) and accuracy independent of image quality.