Robotic spine surgery: Faster, safer, better

In spinal fusions, screws are placed into bones to create an internal cast so that regrowth can occur. There are risks, including neurological damage such as paralysis and injury to the spinal column.

But a new system is making surgeries faster, safer and better.

Jack Stone had a pinched nerve in his leg for four years but didn’t let it stop him from living an active lifestyle. Until one day.

“The scariest thing was when my right leg would go completely numb, very unsettling,” he said.

He knew it was time to get help.

“I came to the conclusion that I didn’t want to live the next however many years I’ve got, 20 or 25 or 30 years in that physical condition,” Stone said.

Jack became one of the first patients in Chicago to undergo spine surgery with new robotic technology. Standard spine surgery requires more time and radiation.

“Each time, we’re taking an X-ray to make sure where the position is of the probe,” Rush University Medical Center Dr. Christopher J. DeWald said. “And then, we take an X-ray before we put the screw, and then we take another X-ray to make sure the screw is in the right location. And that’s a lot of extra radiation, not only to the surgeon but to the patient.”

Instead, the Mazor X system creates a blueprint of the patient’s spine, and a robotic arm guides the surgeon as they place screws into the spine. This allows for less radiation, saved time, lower costs, increased safety and more efficient placement of screws.

“To me, it’s a home run,” DeWald said.

Stone’s surgery was a success.

“I’m really pleased with the outcome, that’s the biggest thing,” he said. “The numbness has gone away, what pain I had has completely gone away.”

And he’s ready to get back to his active lifestyle.

The Mazor X system works by matching a CAT scan of the spine with an X-ray so surgeons can plan placement of the screws on the CAT scan ahead of time.

DeWald said the technology is great for both minimally invasive and more involved surgeries, such as spinal deformity. He is the first in his practice and among the first in the Midwest to use the system.

RESEARCH SUMMARY
MEDICAL BREAKTHROUGHS
TOPIC: ROBOTIC SPINE SURGERY: FASTER, SAFER, BETTER
REPORT: MB #4582

BACKGROUND: Spinal fusion is an operation in which two or more vertebrae are permanently joined together. Compared to just a decade ago, fusions today involve far less trauma to patients. A traditional open fusion involves a large incision in the back to expose the spine, then cutting through and retracting the thick spinal muscles. For minimally invasive fusions, the surgeon requires only a small incision and maneuvers special instruments between the muscles, pushing them aside and protecting them, to reach the spine. Spinal implants are then placed with specialized techniques through this small incision. Microscopes enable the physician to view the area with magnification, allowing for more surgical precision. (Source: https://www.rush.edu/health-wellness/discover-health/5-spinal-fusion-facts)

TREATMENT: Spinal fusion is generally a safe procedure. But as with any surgery, spinal fusion carries the potential risk of complications. Potential complications include infection, poor wound healing, bleeding, blood clots, injury to blood vessels or nerves in and around the spine and pain at the site from which the bone graft is taken. A hospital stay of two to three days is usually required following spinal fusion. Depending on the location and extent of the surgery, some pain and discomfort may be experienced but the pain can usually be controlled well with medications. It may take several months for the affected bones in the spine to heal and fuse together. (Source: https://www.mayoclinic.org/tests-procedures/spinal-fusion/about/pac-20384523)

NEW TECHNOLOGY: According to a press release by Midwest Orthopaedics at Rush, they are the first in Chicago to use the Mazor X™ Robotic Guidance Platform for some of its spinal fusion surgery patients. This technology combines pre-operative imaging and intra-operative guidance, allowing for safer, more efficient spinal fusion surgeries. Mazor Robotics says “3D planning is performed using cutting-edge anatomy recognition and vertebral segmentation algorithms for surgical visualization based on a patient’s images. The resulting surgical plan includes implant and trajectory placement planning. The 3D surgical plan may be created prior to the surgery or during the surgery using Scan & Plan. To execute the surgical plan, the CT-based plan is registered with the patient’s spine and the mounting platform through CT-to-fluoro registration. The mounting platform’s spatial location is marked by a proprietary 3D marker which is attached to it. Two fluoroscopic images of the 3D marker and the spine are taken (anterior-posterior and oblique views). Mazor X software then automatically matches the vertebrae seen in the fluoroscopic images to those in the pre-operative CT. (Source: https://mazorrobotics.com/en-us/product-portfolio/mazor-x/mazorx-how-it-works)