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Robot-Assisted Spine Surgery
What is robot-assisted
spine surgery?
What is robot-assisted spine surgery? At UC Irvine Medical Center, we use a robotic guidance system called SpineAssist® that allows us to perform any spine surgery — from the simplest to the most complex — with greater accuracy, less radiation, less pain and faster recovery. The SpineAssist® system is a state-of-the-art technology that allows the surgeon to develop a three-dimensional surgical blueprint for repairing spine damage and to carry out that plan with robot-assisted precision. The system includes a computerized work station that allows us to use highly sophisticated imaging of a patient’s spine and customize a surgical plan tailored to each patient’s anatomy, then plot precisely — to within one millimeter, or 1/25th of an inch — the location to make incisions and place implants. The surgeon then uses the SpineAssist guidance arm to carry out the preoperative plan. Why is a guidance system important for spine surgery? The spine is a complex system that includes a soft, jelly-like cord containing nerve cells and long tracts of nerve fibers, carrying signals to and from the brain and controlling every function of the body. It is surrounded by a protective column of vertebrae, 33 bones that are separated by cushioning discs of semi-rigid cartilage. When surgery is necessary to repair damage to those discs or to the vertebrae themselves, precision is required to avoid damaging the spinal cord or the webs of nerves leading elsewhere in the body. At UC Irvine, the only medical center in Orange County to use SpineAssist, orthopaedic surgeons use the surgical guidance system to improve accuracy and consistency, as well as to amplify their direct field-of-view during minimally invasive surgery. Independent scientific research has shown that using the robotic system lowers clinical complication rates, reduces pain and allows patients to return to their routines faster when compared to “open” free-hand surgeries. What procedures can benefit from SpineAssist? For patients who have unsuccessfully tried conservative methods to alleviate back or neck pain, UC Irvine Healthcare surgeons perform minimally invasive surgical procedures to correct virtually any spinal disorder. These include:
Does the robot make the incisions? No, SpineAssist guides your surgeon. It does not cut or perform any action on your body. Only the surgeon makes the incisions and places implants, if necessary. Is SpineAssist suitable for minimal invasive surgery (MIS)? A study of the system confirmed that it “support(s) its use in minimally invasive spine surgery applications” (3). SpineAssist enables the surgeon to calmly plan the trajectory before the surgery. Using the AP, axial and lateral views and the slice by slice capabilities, the surgeon can verify the trajectory. This stage replaces the intraoperative visualization and eliminates surprises during surgery. During surgery, SpineAssist safely guides the surgeon to the exact trajectory she planned, thus getting the desired outcome. What is the learning curve for using SpineAssist? Surgeons claim that SpineAssist has a steep learning curve and that after 5-10 cases “the surgical team will gain sufficient experience in operating the SpineAssist miniature robotic device in order to achieve excellent surgical results”(5). It’s ease of use allows fast integration in the surgical workflow (6). How safe is robot-assisted spine surgery? SpineAssist has been used in thousands of surgeries worldwide. The robotic device adheres to international standards and has been approved for use on patients by the U.S. Food and Drug Administration. Multiple scientific studies have shown its value in advancing minimally invasive surgeries, reducing adverse events, facilitating faster recoveries and optimizing patient outcomes. How is surgery with SpineAssist more precise? In open surgery, the surgeon makes an incision large enough to be able to reach the spine and expose a full view of the operating field. In minimally-invasive surgery, the surgeon makes small incisions to allow either “key-hole” visualization of the operating field or by retracting tissue beneath the skin to expose the spine. This means less impact on surrounding tissues, less pain and faster recovery. To compensate for the limited field-of-view, surgeons use fluoroscopy (X-rays) to check their progress. By using the robotic guidance system, the surgeon can more accurately determine the precise place for intervention and reduce the need for multiple imaging procedures, lessening a patient’s radiation exposure. However, the surgeon must always verify that the system’s suggested anatomical site is indeed the desired position. At any stage, the surgeon can decide to continue without the assistance of SpineAssist. Doesn't MIS mean more radiation for the patient and OR staff? Unlike other MIS solutions, SpineAssist actually reduces the radiation. It was demonstrated that “the feasibility of robotically assisted pedicle screw insertion accurately with minimal fluoroscopic utilization and radiation exposure” (7) is gained. SpineAssist guides the surgeon to the exact trajectory without the requirement for any additional fluoroscopy scans. As the surgeon gains confidence with the system’s reliability, she takes the minimally required fluoroscopic scans for verification. What should I expect before my surgery? Please ask your surgeon to provide you with more information about your surgery and how SpineAssist would be used. Back pain can be prevented by practicing proper body mechanics and improving your physical condition. The following can also help keep your back healthy and strong: Exercise – An exercise regimen that includes
conditioning and strengthening exercises can help prevent and reduce
back pain. Core exercises help strengthen abdominal and back muscles
to support your back. Maintain proper posture - Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back. When sitting, choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. Practice safe lifting – When lifting, keep your back straight and only bend at your knees. Hold the load close to your body and avoid lifting and twisting simultaneously. Sleep properly - People experiencing back pain should sleep on a medium-firm to firm mattress. If you sleep on your side, try putting a pillow between your knees. If you sleep on your back, use a pillow under your knees. You can use a small rolled towel to support your lower back. When should you consult your physician about back pain? You should see a physician if you experience numbness or tingling, if your pain is the result of a fall or an injury, or if the pain is severe and doesn’t improve with medications and rest. It is also important to see your doctor if you have pain along with any of the following problems: bowel or urinary dysfunction, weakness, pain or numbness in your legs. Such symptoms may signal a serious problem that requires treatment. When is surgery necessary for patients with spine problems? Most back problems respond to conservative treatments, including anti-inflammatory medication, hot or cold therapy, gentle massage and physical therapy. When conservative treatments don’t alleviate the pain, interventional therapy including epidural steroids, injections, joint and nerve blocks and analgesic pump devices may provide relief. If interventional therapy does not help, back surgery may be considered as a last resort. Back surgery may also be considered in patients experiencing severe pain or when there is a significant neurological impairment, such as profound muscle weakness resulting in a foot drop or a bowel or bladder dysfunction. What are some nonsurgical treatment options for back pain? Most back pain improves over time with a combination of rest, pain relievers, massage and hot or cold therapy. If the back pain persists, physicians may recommend other forms of therapy, including physical therapy and exercise, nonsteroidal anti-inflammatory drugs or, in some cases, a muscle relaxant, cortisone injections or electrical stimulation. Low doses of certain types of antidepressants have been shown to relieve pain. Other alternatives for pain relief may be used for a short period of time under your physician’s supervision. These treatments may include anesthetic injections or self-administered pain medications that are delivered to the spinal cord through a programmed pump. A herniated disc is a "slipped" or "ruptured" disc in the neck or lower back, causing pain in the neck, lower back, arms or legs. Disc herniations can be caused by a trauma including auto accidents, falls or injuries from heavy lifting. However, other patients may develop a herniated disc from repetitive activities or minor injuries. Most herniated discs are responsive to conservative treatments including rest, anti-inflammatory medications, as well as the possible use of steroids and physical therapy. If conservative treatments fail, physicians may recommend a microdiscectomy, a minimally invasive technique, in which the disc can be shaved to alleviate the pressure on the nerve. Can osteoporosis cause a spinal fracture? Individuals with osteoporosis are at higher risk for developing spinal or compression fractures. The condition occurs when the weight of the upper body exceeds the ability of the spine to support itself. Traditional conservative treatment includes bed rest, pain control and physical therapy. Interventional procedures such as vertebroplasty can be considered in those patients who do not respond to initial treatment. Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra that has been weakened by osteoporosis.
Questions? Contact the Comprehensive
Spine Program
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Does a Critical Rotator Cuff Tear Stage Exist?: A Biomechanical Study of Rotator Cuff Tear Progression in Human Cadaver Shoulders. Read Article... Joo Han Oh, MD, PhD; Bong Jae Jun, PhD; Michelle H. McGarry, MS; Thay Q. Lee, PhD Dr. Ranjan Gupta recently served as an Instructor for the Comprehensive Review Course in Hand and Upper Extremity Surgery in Chicago this July 15-17, 2011. He provided information to practicing hand surgeons about nerve injuries and their reconstruction as they prepared to take their certifying examinations. In addition, he taught at the AAOS/ASES Advanced Surgical Management of Complex Shoulder Instability at the Orthopaedic Learning Center in Rosemont, Illinois July 22-22, 2011 along with other shoulder experts. He demonstrated new surgical techniques to practicing orthopaedic surgeons as they learned to explore evolving treatment options for complex shoulder instability. Please visit our new Orthopaedic & Sports
Medicine Center in 1640 Newport Blvd.,
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