Surgery for Spinal Deformity
(Scoliosis or Kyphosis)
1.Spinal deformity correction is one of the biggest operations in spine surgery. It involves joining together multiple spine segments and putting multiple screws, cages and rods. Typically, it is done from the back. This is called a posterior approach. At times, the operation needs to be performed from the front. This is called an anterior approach. Sometimes a circumferential or a 3600 approach is necessary. Because of the number of levels involved, the spinal deformity operations tend to be quite long and may take anywhere from 6 to 12 hours. There is a chance that after the surgery, the patients may be kept intubated over one or two nights in the ICU to decrease the swelling around the face and the airway. This is typically decided jointly by the anesthesiologist and the surgeon at the end of the case.
Since the operation takes place around the spinal cord and the spinal nerves, we take all the precautions to ensure the neurological safety. We typically employ multiple neuromonitoring modalities throughout the case to minimize the risk of a neurological injury. The neuromonitoring is done by a neuromonitoring technician, who is present in the room throughout the entire operation. Typically, a neurologist overseas the technician remotely. The neuromonitoring involves placing multiple needles in both arms, legs, and scalp for monitoring spinal cord and nerve root signals. Neuromonitoring typically would give us some early alerts about any impending neurological problems, so that an action can be taken to avoid it. Despite of the neuromonitoring and the advanced nature of spine surgery in general, there is still a small risk of a neurological injury. Typically, this can involve injury to the spinal cord or spinal nerves. The majority of neurological problems are transient and reversible. The risk of some degree of a persistent neurological problem is around 5%.
2. Blood loss: The long operations tend to have a potential for a significant blood loss. Quite often, the patients require transfusions especially in cases of adult spinal deformity associated with three-column osteotomy. The patients may require a combination of Cell Saver blood, which is the patient’s own blood cleaned through an extraneous filter and given back to the patient. In addition, the patient may require blood transfusions from the blood bank as well as platelets, clotting factors and fresh frozen plasma. The blood bank has multiple procedures in place to minimize the chance of a transfusion reaction and minimize the chance of transmission of any pathogens such as viruses and bacteria.
3. Eye problems: There is a rare phenomenon of spinal blindness. It is a very uncommon event previously associated with a direct pressure over the eyes. The modern spine tables have special pieces that avoid any direct pressure over the eyes. Typically, the visual disturbances after spine surgery in the modern day are not due to a direct pressure over the eyes but are rather due to preexisting eye problems and fluctuations in the blood pressure intraoperatively. The chance of spine surgery associated eye problems is around 1 in 1000.
4. Revision surgery: In general, the chance of returning to an operating of any reason after spinal deformity operation is about 1 in 4. The reason for return to the operating room can be multifold ranging from postoperative infection, need to reposition hardware or hardware failure. The risk of rod fracture in spinal deformities is approximately 1 in 6. Not all hardware failures require revision surgery, typically only if they cause any symptoms.
Robots in Spine Surgery
The use of a robot is one of the newest technologies in spine surgery. It is a guidance system allowing surgeons to perform a wide range of spinal surgeries with greater accuracy, safety, and speed. Since there is reduced use of fluoroscopy or x-rays, radiation exposure to the patient is significantly minimized. We have been using the Mazor Renaissance robot since 2014. It is based on a computerized pre-operative plan and increases precision to an accuracy of 1 mm. It is especially effective for pedicle screw placement. In the past, surgeons inserted screws into the spine by “freehand” or by obtaining x-rays images using the long repeated fluoroscopic exposure. These older techniques posed a significant risk of misplacing the screws. Without robotic guidance, the rate of screw misplacement is up to 10% and nerve injury up to 2%. Using our Mazor robot, the rate of accurate screws placement increases to at least 98%.
How Does Robotic Spine Surgery Work?
Robotic Spine Surgery Benefits
Spine surgery can be a scary prospect for a lot of patients. Worries about accuracy, patient outcomes and recovery time are common. Thankfully, when it comes to spine surgery performed with the Renaissance® Guidance System, you can rest easy.
Independent clinical research has shown that minimally-invasive surgery with Mazor Robotics technology provides the following benefits:
- Promotes Faster Recovery: Patients who have surgery performed with the Renaissance® Guidance System can experience faster recovery time, allowing them to return to their normal daily activities in less time than those who received surgeries via traditional methods.
- Reduced Post-Operative Pain: Clinical studies have shown patients may experience less pain following spine procedures performed with the assistance of the Renaissance® Guidance System.
- Lowered Complication Rates: Clinical studies based on surgeries performed with the Mazor Robotics Renaissance® Guidance System have shown increased favorable patient outcomes, including lowered surgery complication rates.
- Increased Accuracy: With the help of Mazor Robotics, spine surgery accuracy is increased. 3D planning software maps out the procedure, while the Renaissance® Guidance System guides the surgeon’s tools within 1.5mm accuracy.
Robotic Spine Surgery FAQs
What is The Renaissance® Guidance System?
Renaissance® is Mazor Robotics’ surgical guidance system that allows surgeons to perform spine surgery–from the simplest to the most complex–safely, accurately, and efficiently while optimizing clinical outcomes. Independent scientific research has shown that using Mazor Robotics technology in minimally-invasive surgery (MIS) increases surgical accuracy, lowers clinical complication rates, reduces pain, and enables faster recovery and return to daily activities. Research has also shown its superior accuracy, up to 98.3 percent (compared to approximately 90 percent in freehand procedures), in complex surgeries such as scoliosis corrections.
How many procedures have been performed using Mazor Robotics Technology?
Over 50,000 spine implants have been placed in approximately 10,000 procedures.
How will my surgeon work with Renaissance®? Is it independent?
Your surgeon will select the best treatment for your specific condition. Based on your CT-scan, your surgeon will use Renaissance’s advanced 3D planning software to plan the optimal surgery customized for your anatomy and diagnosis. Once in the operating room, Renaissance guides your surgeon precisely to the preplanned anatomical location where intervention is necessary.
Renaissance is not independent and does not cut or perform any action on your body. Only your surgeon performs the required procedures such as placing implants. Your surgeon is in full control of the system at all times. Also, at any stage, your surgeon can decide to continue without the assistance of Renaissance.
What are the advantages of minimally-invasive surgery with Renaissance®?
In open surgery, the spine is exposed through a large incision to allow a full, direct field-of-view and access to the surgeon’s hand and tools. In minimally-invasive surgery, the surgeon makes small skin incisions to allow visualization of the operating field by retracting the tissues beneath the skin and exposing the spine. To compensate for this limited field-of-view, surgeons use fluoroscopy (X-ray) images to view their progress. Yet, even with imaging, comparative studies demonstrate that MIS accuracy is lower than in open surgeries (which offer a better, direct field-of-view). So, there is usually a clinical trade-off between accuracy versus the advantages of MIS. With Mazor Robotics Renaissance® Guidance System, spine surgery patients benefit from high levels of accuracy and the advantages of minimally-invasive surgery. Independent scientific research has shown that minimally-invasive surgery with Mazor Robotics technology lowers complication rates, reduces postoperative pain, and aids in faster recovery with a quicker return to daily activities when compared to open, freehand surgeries.
What are the clinical benefits of Mazor Robotics Technology?
Renaissance® Guidance System takes spine procedures to the next level with its consistent accuracy. Furthermore, Renaissance better enables minimally-invasive surgery by replacing the surgeon’s need for a direct field-of-view with a surgical guidance system. Independent scientific research has shown that minimally-invasive surgery with Mazor Robotics technology increases surgical accuracy, lowers complication rates, reduces postoperative pain, and aids in faster recovery with a quicker return to daily activities when compared to open freehand surgeries.
How precise is spine surgery with Mazor Robotics Renaissance® Guidance System?
Renaissance® Guidance System is designed to provide consistent accuracy to 1.5mm (1/17 inch). The accuracy of Mazor Robotics technology has been clinically validated in studies worldwide. For example, a recently published study demonstrated 98.3 percent accuracy for placing 3,271 implants in 635 cases in 14 international medical centers.
How Safe is the Surgery with Renaissance® Technology?
Renaissance® Guidance System is powered by Mazor Robotics clinically proven technology– used in thousands of surgeries worldwide, including placement of tens of thousands of implants. Like all Mazor Robotics systems, it strictly adheres to international standards and has received FDA clearance in the USA and the European CE Mark.
to find out if you are a candidate for robotic spine surgery with the Renaissance® system in San Francisco, CA.