SPINE
Our practice has developed a reputation for identifying key components of future-minded surgical innovation, becoming experts in that technology, and then championing its use to take care of the members of our community and region at large.
Robotic-assisted surgery for the spine is one of those components, and it has truly changed the field in a monumental way. In this blog, we will go over what exactly robotic-assisted surgery is and the benefits of using the technology during your surgical procedure.
When does your spine surgeon use the robot?
Great place to start. To give you the short answer first – we use the robot to place screws and cages during fusion surgeries of the thoracic and lumbar spine. But let us back up a bit and give you some more background. There are essentially two different types of surgeries that the majority of spine surgeons perform on the lumbar spine.
The first surgery is called a decompression, and there are many different types of decompression surgeries, during which bone, ligaments, and/or pieces of disc material are removed to take pressure off of nerves in your back. The point of this surgery is to alleviate pressure on that nerve so that the disabling pain you have been feeling shoot down your leg, along with the numbness and strength issues you may have been having along side this, can finally improve. Some of these surgeries are called “laminectomies,” “foraminotomies,” or “discectomies.”
The second surgery is called a fusion, which is often combined with a decompression. We perform fusions for several different reasons: instability or “spondylolisthesis”, curves of the spine or “scoliosis”, severe nerve narrowing in the small hole through which the nerve exits your spine to go to your leg, or “foraminal stenosis” are just some of these reasons. A fusion in and of itself means we are trying to take two or more bones (or vertebrae) in your spine and turn them into one bone, and we rely on engineered implants (screws, cages, and rods) and your own body’s biology to do just that. It is during this process of placing these implants – screws, cages, and rods – into your spine that we use the robot.
Why is this so beneficial to me as a spine-surgical patient?
There are a number of reasons, but they all come down to creating a tailored plan that is completely individualized to your specific anatomy (because everyone is built just slightly differently) and then executing that plan. Before we ever even step foot inside of the operating room, we obtain a CT scan of your spine – which is different from the MRI you’ve already had of your spine. MRIs are great for giving us a really good understanding of the soft tissue elements of your anatomy that are causing a nerve problem, while CTs are excellent for providing us with excellent detail to understand your spine's bony anatomy. Because we are placing these screws into the bone of your spine, we use the CT scan to come up with the pre-operative plan for your surgery. And because that CT scan gives us such great detail of your spine’s bony anatomy, we can ensure that the implants are the correct width and length and that they will be placed at the correct angle for your spine specifically.
During surgery, we take a series of x-rays of each of the vertebrae in which we need to place screws and cages, and we then give that information to the robotic software; once we know that the software has correctly married the CT scan data that we obtained before surgery with the x-ray data that we obtained during surgery, we can then proceed with placing the implants into your spine. To start this process, we drape the robot with a sterile drape, and we bring the robot close to your body while you are asleep under anesthesia. A secure arm comes out to the side of the robot and helps identify the angle that we need to place each of our screws and cages. We, as your surgeons, are then putting tools and instruments through the arm of the robot to ultimately place the screws and cages into the exact area and at the exact depth and angle that we planned on the CT scan. It may come as no surprise that each of these screws does need to be placed in a safe and reliable place within your spine – they should not be up against nerves, and they should be well-anchored into solid bone. The CT scan helps us make sure that we’ve achieved both of those goals for each of those screws.
The classic old-school technique of placing screws into the spine would call for your surgeon to rely on their understanding of the anatomy – which we must all have as surgeons – and then using that educated guesswork to then place the screws and cages into your spine. This is a process that takes a lot of time and potentially a lot of radiation during surgery to complete. But with the robot, we’ve planned the screws with using a very detailed and personalized roadmap to your spine in the form of the pre-operative CT scan – so, we really take all of that educated guesswork away. And this process of placing the screws and cages can happen much more efficiently. We can get you on and off of the table much faster; the less time you are under anesthesia, the easier it is for you to recover. With the use of the robot, we can also use smaller incisions and disrupt the muscle less because we have very fine-tuned guidance to your spine. With less muscle disruption during surgery, you feel much less pain after surgery, which makes it much easier for you to recover after surgery.
So, to outline some of the benefits of using robotic-assisted technology during spine surgery that we’ve just discussed:
Is the robot doing my surgery?
Great question, and we get this a lot. My hope is that the prior section helped you understand how the robotic spine surgical process occurs. Still, answering this question separately may help many patients gain some comfort around the idea of robotic surgery.
The quick answer is no, the robot is not doing the surgery for you or for me. It is truly robotic-assisted surgery, meaning the robot assists your surgeon in doing your surgery for you. I describe the robot as a very steady set of hands acting as my assistant so that I can make sure each of the screws and cages that I am placing in your spine can go into the exact place I want them each to go. We get that pre-operative CT scan of your spine so that we can plan each screw and cage in the exact safe and effective manner that it should be placed in your spine before we ever enter the OR. We then get a series of x-rays during surgery so that we can give the robot intra-operative data and can then use the pre-operative CT scan data to begin placing the screws and cages in the way that we planned them. The robotic arm then moves into the exact position and angle so that your surgeon can place tools and instruments through that arm and ultimately place the screw into the exact desired location. We repeat this process for each screw and cage. Because we are no longer using that educated guesswork, we can help you get through this surgery much faster and with smaller incisions. But remember that it is your surgeon that is passing the instruments and placing the screws and cages through the robotic arm - the robotic arm is just another tool that helps your surgeon be more precise, accurate, and efficient.
I hope that was a helpful rundown of robotic spine surgery. I should say that a number of additions emerging over the next 12-24 months, like artificial intelligence algorithms and improved navigation capabilities, will make this technology that much more powerful and efficient in spine surgical care. This really is just the beginning of where this technology can take us. You can count on your spine surgery team to be at the forefront of this next chapter.
