Robotic spine surgery uses a spinal robot and navigation to help plan and place screws, cages, and other implants accurately when a fusion or stabilization is part of the plan. The robot does not do the surgery. The surgeon does.

At HSS at NCH in Naples, Dr. Nicholas J. Clark, an orthopedic spine surgeon trained at Mayo Clinic and Hospital for Special Surgery, uses the Globus ExcelsiusGPS robot at NCH for selected cases. Dr. Clark has extensive experience with robotic-guided spine surgery. It is not used for every operation, and it is never used to replace surgical judgment.

Patients researching robotic spine surgery in Southwest Florida often find that the useful question is not "Does he have a robot?" It is "Does my plan need precise implant placement, and is the robot the right tool for that?" That is the conversation at HSS at NCH.

Who robotic spine surgery is for

Robotic guidance may be part of the plan for adults who:

• Need a spine operation that includes screws, cages, or other implants, most often a lumbar fusion

• Have a slip (spondylolisthesis), instability, or a collapsed disc that needs to be stabilized

• Have prior spine hardware that may need to be revised, extended, or replaced

• Are good candidates for a minimally invasive (MIS) approach, where accurate placement through small openings matters

Robotic guidance is usually not the right tool when:

• The main job is taking pressure off a nerve without a fusion, such as a microdiscectomy or a decompression. Dr. Clark does not use the robot for decompression.

• Therapy, medicines, injections, or activity changes still have a realistic chance to help. Surgery is not automatic.

• Scar, anatomy, or deformity makes a different approach safer

What the robot actually does

Robotic guidance has three parts.

1. Planning. Imaging of the spine is used to build a map. The surgeon uses that map to plan where each screw or implant should go, including its angle and size, before committing in the operating room.

2. Navigation. During surgery, the patient's spine is matched to the map. Cameras track the instruments so the surgeon can see them against the bone on a screen in real time.

3. Guided placement. The robotic arm moves to the planned path and holds a guide steady. The surgeon then places the hardware through that guide, along the path the surgeon chose.

What the robot does not do:

• It does not operate on its own or run on autopilot

• It does not decompress nerves. That work is done by the surgeon by hand.

• It does not make decisions. If the anatomy or findings in the operating room say the plan needs to change, the surgeon changes it.

The main goal is accuracy. Spine screws sit close to nerves, the spinal cord, and blood vessels. A good plan, followed closely, helps put hardware where it was intended.

Procedures where the robot is used

In Dr. Clark's practice, robotic guidance supports the hardware part of selected operations, including:

• MIS-TLIF (minimally invasive transforaminal lumbar interbody fusion). Pinched nerves are decompressed and an unstable level is fused through a small muscle-sparing corridor. The robot is often used to place screws and rods accurately through that corridor.

• LLIF (lateral lumbar interbody fusion). The disc is reached from the side to restore height and open the nerve tunnel. Posterior screws and rods are often added, sometimes with robotic or navigation help.

• MIS ALIF (anterior lumbar interbody fusion). The disc is reached from the front. When posterior screws are also needed, such as for a slip or instability, Dr. Clark uses robotic guidance to place screws and rods through small skin openings in the back (posterior percutaneous screw fixation).

• Revision spine surgery. When prior implants need revision, extension, or replacement, mapped guidance can make placement more precise in selected cases.

The robot is not used for ACDF or cervical disc replacement. These neck operations are done from the front without robotic guidance.

Benefits

When hardware is part of the plan, robotic guidance can help:

• Plan each implant on a map of the patient's own spine before surgery starts

• Place screws accurately along the planned path

• Make smaller, muscle-sparing incisions more practical, which may mean less soft-tissue disruption

• Lower x-ray (radiation) exposure during surgery, because fewer repeated x-ray shots are needed

What it does not change is just as important. The robot does not make bone heal faster, shorten the recovery rules, or guarantee a better result for any one patient.

Risks and limits

Robotic spine surgery has the same core risks as the operation it supports. These include anesthesia risk, infection, bleeding, blood clots, nerve injury, spinal fluid leak, hardware problems, and the chance that the bones do not fuse (nonunion). A level next to a fusion can also wear out over time.

Limits specific to the robot include:

• Accuracy depends on the map. If the map and the patient's spine stop lining up during surgery, the plan is checked again. If needed, the team switches to standard techniques.

• Not every case fits. Very soft bone, some deformities, and heavy scar tissue can make robotic guidance less useful or not useful at all.

• Fusion is still biology. Nicotine, diabetes, and bone quality still matter.

Recovery

Recovery follows the operation, not the robot. For most robotic lumbar fusions, the shared lumbar fusion rules apply. Written discharge instructions win if they differ.

• Hospital stay: Most people stay overnight after MIS-TLIF or LLIF. ALIF can be same-day or overnight. Same-day discharge is case by case.

• Brace: A short LSO brace is typical after lumbar fusion, worn as written.

• Walking: Walking is the main exercise. Short walks in weeks 0 to 2. If healing looks right at the 2-week visit, unlimited walking on even ground in weeks 2 to 6.

• BLT: No extra bending, lifting, or twisting for 6 weeks.

• Driving: No driving for the first 2 weeks. After that, only if at least 2 weeks out and off all narcotics. Both are required.

• Bathing: Showering is usually fine once cleared. No tub, pool, ocean, or hot tub for 6 weeks.

• Nicotine and NSAIDs: Nicotine is a hard stop for fusion. No NSAIDs (ibuprofen, naproxen, Advil, Aleve) for 3 months after fusion unless an exception is written.

Early visits are usually with Jorge Monje, APRN (Spanish and English) at about 2 and 6 weeks. Dr. Clark typically sees fusion patients at about 3 and 6 months, and sometimes around a year. Week 6 is a check-in, not proof the fusion is done.

New loss of bowel or bladder control, new numbness in the groin or "saddle" area, or rapidly worsening leg weakness is an emergency. Call 911 or go to the ER.

Why Dr. Clark and HSS at NCH

• Fellowship-trained orthopedic spine surgeon: spine fellowship at Hospital for Special Surgery and orthopedic residency at Mayo Clinic

• Extensive experience with robotic-guided spine surgery, using the ExcelsiusGPS robot at NCH

• A preference for the least invasive plan that accomplishes the goals, and for motion preservation when it is safe

• Surgery performed at NCH hospitals, with clinic at HSS at NCH, 11190 Health Park Blvd, Building 2, Suite 2102, Naples, FL 34110

• Serving Naples, Estero, Bonita Springs, Fort Myers, and the wider Southwest Florida community

FAQs

Does the robot do the surgery?

No. The robot helps plan and guide accurate hardware placement. Dr. Clark performs the decompression and makes every surgical decision.

Is robotic spine surgery the same as minimally invasive surgery?

Not exactly. MIS is a way of reaching the spine through smaller openings. The robot is a tool for placing hardware, often in MIS cases. Many MIS operations use no robot.

Will my surgery be robotic?

Only if the plan includes hardware and the robot adds value for that case.

Is robotic surgery safer?

The goal is accurate placement, which matters because screws sit near nerves and vessels. It does not remove the normal risks of spine surgery, and no result can be promised.

Does robotic surgery mean a faster recovery?

Not by itself. Recovery depends on the operation, the number of levels, and overall health. The fusion rules for walking, bracing, driving, nicotine, and NSAIDs stay the same.

Can I get a second opinion about robotic surgery?

Yes. Second opinions are welcome, and a review does not require a commitment to surgery or to the robot.

Talk with Dr. Clark about robotic spine surgery

If a fusion or hardware revision has been recommended, or you want to know whether robotic guidance fits your spine problem, call our team at (239) 624-0306. New patients are usually seen within 7 to 10 days, and sooner when the problem is urgent. An MRI and a course of physical therapy before the first visit are preferred. Bring any imaging, reports, and prior operative notes you have.

Call (239) 624-0306 · Request an appointment

Nicholas J. Clark, MD, orthopedic spine surgery (minimally invasive and robotic), HSS at NCH, Naples, FL. This page is educational and not medical advice for your specific condition.