Robot-Guided Spine Surgery
Virginia Spine Institute is proud that, Dr. Thomas Schuler and Dr. Christopher Good made a breakthrough in spinal surgery in July 2012 by performing the first robot-guided surgery in the Mid-Atlantic Region at HCA Reston Hospital Center. Our spinal specialists are leaders in modern spinal health care. This new technique provides our surgical patients with smaller incisions for faster recovery time, less exposure to radiation, and improved surgical accuracy. This decreases overall risk during surgery. The experts at Virginia Spine Institute will continue to use this new technique to perform both minimally invasive spine surgeries and complex spinal reconstructive surgeries. All of our Spinal Specialists at Virginia Spine Institute are trained in the Renaissance™ Robotic system and are double board certified in their chosen specialty of orthopedic surgery or neurosurgery, as well as spinal surgery.
“Robot-assisted surgery represents a major technological breakthrough for patients. My experience with robotic surgery began six years ago and it is very exciting to see the progress that has been made. Robot-assisted surgery helps make surgery safer and I am proud to be able to offer this revolutionary technology to my patients.” - Dr. Christopher Good.
- Mazor Robotics
- Minimally Invasive Spine Fusion
- Scoliosis Correction Surgery
- Spine Biopsy
The Mazor Robotics’ Renaissance system is one of the only robotic guidance products in the United States used for implanting devices during spine surgery. The Mazor Robotics system allows our surgeons to use images from a computerized tomography scan (CT scan) that is taken before surgery to create a blueprint for each surgical case. These images are loaded into a computerized 3D planning system allowing our surgeon to plan the procedure with a high degree of precision before ever entering the operating room. In the operating room, our surgeons do all the physical work of the surgery. The robot-guidance system helps guide the surgeon’s instruments based on highly accurate pre-operative planning of spinal implant placement. During the surgery, the robot is placed near the patient either by attaching it to the bed or directly anchoring it to the spine of the patient. The robot is approximately the size of a soda can with a small arm attached. It can bend and rotate in order to place its arm on the spine in a very specific location and trajectory. This ultra-precise guidance improves our surgeon’s ability to safely place implants, particularly when working through very small incisions or when dealing with complex anatomy.
"This monumental advancement will reshape the future of spine surgery. It is rewarding to be able to elevate the level of safety for patients while helping them recover faster and return to full active lifestyles again.“ - Dr. Thomas Schuler.
Minimally invasive surgery uses smaller incisions which usually cause less damage to surrounding healthy tissue, less post-operative pain, and a faster recovery. Traditionally, spine surgery requires “open” surgery with incisions large enough to expose the entire area being treated. Open surgical techniques are beneficial and necessary for many conditions; however, in some cases minimally invasive surgery can be safely used for a similar result. One common technique the spine surgeons at the Virginia Spine Institute use to correct spinal conditions is spinal fusion. The purpose of a spinal fusion is to fuse, or join together, two separate segments of the spine to correct misalignment or instability.
Minimally invasive surgery often relies on more x-rays in the operating room since the surgeon can’t directly see the spine. The increased radiation exposure from more x-rays during surgery increases the risk of cancer for the patient as well as the health care team.1 Robot-guided technology allows our surgeons to operate very accurately through a small incision while also decreasing the need for radiation during the surgical procedure. This advanced technology results in less bleeding, smaller scars, less pain, and faster recovery.
A recent study reviewed 635 surgeries involving the placement of 3,271 spinal implants and found a 98.3% accuracy rate for implants placed with robot guidance. In this study, 49% were defined as minimally invasive surgeries. The study reported an improvement in accuracy of instrumentation placement and lower risk for neurologic issues compared to previous studies.2 Robot-guidance has been directly compared to open surgical techniques, and in one retrospective study demonstrated an improvement in implant accuracy by 70%, reduction in radiation dose by 56%, and decrease in hospital stay by 27%.3
Scoliosis is an abnormal curvature of the spine that affects approximately seven million people in the United States. Adolescent idiopathic scoliosis is most commonly diagnosed between the ages of 10 to 12 years old and may be discovered by parents, during school screenings, or at pediatric visits. Symptoms of scoliosis may include back pain, uneven shoulders or hips, abnormal gait, breathing issues, and neurologic problems. Treatment options for idiopathic scoliosis include observation, bracing, and surgery based on the severity of the patient’s curvature. In general, bracing is recommended for curves between 25–30° in patients who are still growing. Corrective surgery is generally reserved for progressive curves greater than 45° or curves that do not respond to bracing treatment. The goals of scoliosis correction surgery are to improve the spinal curvature and to prevent the curve from progressing further during the patient’s life.
Surgery for scoliosis involves the use of spinal instrumentation such as screws, rods, hooks, and wires which are placed along the spine. It corrects the abnormal curvature and prevents further progression of the disease. Surgical treatment of scoliosis requires a high degree of planning and precision. Each specific curve pattern is unique, and many patients have abnormally shaped vertebrae making the surgery more challenging. Robot-guided scoliosis surgery increases correctness of where the surgical instrumentation is placed. This increases the safety of the surgery and allows our scoliosis Specialist, Dr. Christopher R. Good, the ability to customize an ideal surgery for each patient.
Studies validate superior clinical results for adolescent scoliosis reconstruction with robotic technology based on improved accuracy of implant placement and safety. In a recent study of 120 teenagers with scoliosis, robot guided surgery was found to achieve 99.7% accuracy of 1,815 implants placed.3
Vertebroplasty is an outpatient procedure commonly performed for the treatment of osteoporotic compression fractures. During the procedure, synthetic bone cement is injected into a broken spine vertebra through a needle. The cement hardens in a few minutes after it is injected to stabilize the fractured bone. This decreases pain and the potential for the bone to break further.
Vertebroplasty demands a high level of precision since a needle is guided through the vertebra near the spinal cord or nerves. The needle location is very important to prevent any bone cement from flowing into the area around the nerves in the spine. Robot-guidance allows our surgeons to position the needle precisely to minimize risks surrounding this procedure.
In a recent study of osteoporotic compression fractures, robot-guidance was shown to be more accurate than traditional methods. This reduced the total time needed and in some cases, allowed the procedure to be performed on patients who would not have been able to be treated normally.4 The use of the robot has also been reported to decrease radiation exposure to the patient and operating room staff by 50–70% in vertebroplasty procedures.5
In some cases, it is necessary to obtain a small piece of tissue from the spine in order to perform microscopic studies. This is particularly true in cases of spinal tumors to determine if a lesion is benign, malignant, or infected. Biopsies are usually taken with a needle through a small incision without direct visualization of the tumor. In many cases, surgeons use CT scans or X-ray images to guide the needle into the correct location. This process involves additional radiation and in some cases it can be difficult to find the right spot for the biopsy. Robot-guidance allows our surgeons at the Virginia Spine Institute to pinpoint the exact location for the biopsy reducing the amount of radiation and the time needed for surgery.
Robot-guided spine surgery is a promising new technology that has many advantages. Innovative techniques allow our surgeons at Virginia Spine Institute to perform less invasive surgical procedures with smaller incisions, less operative bleeding, faster recovery time and shorter hospital stays. These procedures are performed with less radiation exposure to patients and health care providers. Robot-guidance also can increase the accuracy and safety of surgical procedures allowing for better outcomes and a healthier you.
New Horizons in Treatment: Robot-Guided SurgeryViews 15170