Jeffrey Goldstein, Chief of Spine Service for education and Director of the Spine Fellowship at NYU Langone Orthopedic Hospital, formerly known as the Hospital for Joint Diseases, (one of the top hospitals in America and the only one to receive top rankings in all three musculoskeletal specialty areas by U.S. News & World Report) is on everyone’s short list to review new technology.
He was a pioneer in the use and testing of disc replacement implants, early in the adoption of minimally invasive spine surgery techniques and this year’s President of the International Society for the Advancement of Spine Surgery. He has also been a robot skeptic.
Until now.
Robot assist devices in the OR are a new phenomenon. Robots to fabricate cars—old hat. But robots to repair humans…skepticism is a logical default position. And Dr. Goldstein has been a tough customer for the companies promoting the latest robots.
So, what changed?
We met with Dr. Goldstein at the NYU Langone Orthopedic Hospital in the heart of lower Manhattan for a candid discussion about these new surgical robots.
We started by asking him to describe how his thinking has evolved over the past decade.
Dr. Goldstein: “It was funny when you asked me about the evolution of my experience with robots. I remember sitting downstairs nearly a decade ago and having somebody from the first spine robot company, Mazor, come in and show me this thing that looked to me like a soda can.”
“My perception then was that it was designed for revisions surgeries where you couldn’t see your landmarks well or for long deformity surgeries. At that point we were very comfortable with putting screws in open surgery. I frankly wasn’t sure how it was going to help me. I just imagined this slowing me down. It wasn’t until maybe the past two years that I started seeing a place for robotics.”
OTW: Do you think the companies actually got smarter about indications or do you think your practice changed? Maybe both?
Dr. Goldstein: “I think initially it was: ‘Let’s take this robot and help you put a screw in.’ But we know how to put a screw in. I think when we started doing minimally invasive spine surgery, initially tubular surgery, that was probably when I took another look at robotics. Minimally invasive spine surgery, which is different than the micro-discectomy cases, meant doing fluoroscopically guided surgery with percutaneous pedicle screws. This was a big advance. The evolution from open surgery to minimally invasive surgery to robotic and navigation guided surgery set the stage for robotics.
