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Back Surgery Breakthrough

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ORLANDO, Fla. ( Ivanhoe Newswire) - Millimeters matter in the operating room. If surgeons miss their mark the results can be devastating. Now, doctors have a pint-sized tool to help them hit their target during a popular procedure.

Gail and Paul Wells met and fell in love after they both lost their spouses.

"We just clicked," Gail Wells told Ivanhoe.

The newlyweds love to travel but long trips were painful for Gail.

"Sitting was really difficult," Gail said.

She had degenerative spinal stenosis.

"Two disks were way out of filter," Gail said.

"The result of that is a narrowing of the spinal canal, which is a very common problem that we see as we get older," Faissal Zahrawi, M.D., from Florida hospital, explained.

Doctor Zahrawi suggested spinal fusion, but instead of free-handing the hardware into Gail's back he used the Mazor Renaissance.

"The robot aids in the insertion of these screws and rods," Dr. Zahrawi said.

Before the procedure, detailed scans are taken giving surgeons a 3D look at the spine.

"Which we've never seen before," Dr. Zahrawi said.

The info is sent to the robot, and then during the operation it guides surgeons on where to place the hardware. Doctor Zahrawi said the free-hand technique can be up to five-percent off the mark. The robot gets him within one millimeter.

"The safety factor is huge," Gail said.

A month after surgery and Gail's back on track.

"Oh, I'm walking miles, sometimes five miles a day," She said.

Enjoying time with her husband as they plan a trip to Tahiti.

"We have nothing holding us back from our future adventures. We can pretty much do what we want to now," Gail said.

The doctor said if spinal fusion surgeries aren't done correctly lower back and leg pain can continue. He believes the robot considerably lowers those risks. He adds that it also helps cut down on radiation exposure by 80 percent because fewer X-Rays are needed during the surgery.

RESEARCH SUMMARY

SPINAL STENOSIS: Spinal stenosis usually occurs as a person ages and the disks become drier and start to bulge. At the same time, the bones and ligaments of the spine thickens or grow larger due to arthritis or long-term swelling (inflammation).

Spinal stenosis may also be caused by:

  • Arthritis of the spine, usually in middle-aged or elderly people
  • Bone diseases, such as Paget's disease of bone and achondroplasia
  • Defect or growth in the spine that was present from birth (congenital defect)
  • Herniated or slipped disk, which often happened in the past
  • Injury that causes pressure on the nerve roots or the spinal cord
  • Tumors in the spine

Sometimes a spinal fusion is performed to relieve the pressure on the nerves or spinal cord. (Source: www.ncbi.nlm.nih.gov)

SPINAL FUSION RISKS: 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
  • Pain at the site from which the bone graft is taken

Beyond the immediate risks of the procedure, spinal fusion surgery changes how your spine works by shifting stress from the fused vertebrae to adjacent areas of your spine. This added stress may accelerate the process of wear and tear in the vertebral joints on either side of the fusion, causing further damage and possibly chronic pain. (Source: mayoclinic.com)

THE "SPINE ROBOT": Renaissance, Mazor Robotics' guidance system, enables surgeons to perform safer and more accurate spine surgeries. For patients, this means better clinical outcomes with less pain and fewer complications, enabling a faster recovery and return to daily activities.

Using RenaissanceTM in MIS helps surgeons overcome field-of-view limitations by pinpointing surgical tools to the exact anatomical location, without compromising accuracy, safety and without increasing the length of surgery or radiation levels. So, patients can enjoy the clinical benefits of MIS without the need for additional radiation or compromising on accuracy. (Source: celebrationspinecenter.com)

INTERVIEW

Faissal Zahrawi, MD from Florida Hospital, talks about how a glowing robot is helping patients get glowing results after a common surgery.

What is spondylolisthesis

Dr. Zahrawi: There are two main kinds of spondyloisthesis; degenerative and congenital. Degenerative is the more common one and that is what Gail has. It is common as we get older and more common in women. It is a slippage of the vertebra as a result of arthritis and loss of the integrity of the facets joint that hold the vertebra together. It is commonly associated with stenosis due to thickening of the ligament and change in the geometry of the spinal canal. That stenosis resulted in pain, inability to walk for a distance and tingling and numbness in the legs and feet. This the kind of problem Gail had.

Were doctors surprised Gail could walk?

Dr. Zahrawi: Yes. That is what this condition results in. It will slow the individual's activity taking away their sport and life enjoyment.

What was the traditional solution for someone who has spinal stenosis?

Dr. Zahrawi: The traditional surgery which still very common till this day, which we all learned in our training years ago, is midline wide decompression and fusion. The result of course is decompressing the nerves and stabilizing the slipped vertebra. Now with the minimally invasive surgery, we do the exact same procedure through a small incision less than an inch (compared to four to five inches in the old technique), we can decompress the nerves and we can stabilize the vertebra through separate 1/3 inch incisions. That is what we call minimally invasive spine surgery.

What is the difference between the new and old technology?

Dr. Zahrawi: With the standard surgery we make midline incisions usually large enough to reach both sides, right and left, retract the muscles for two to three hours at time. That results in a lot of pain post operatively. With the new technique we make small incision we do not retract muscles. We dilate them with tubes and use microscopes and C-arm x- ray for accuracy and localization. The result is less pain, shorter hospital stay, faster recovery, fewer complications and better outcomes.

When you are doing this procedure, are you taking X-rays pretty consistently?

Dr. Zahrawi: That is the draw back for minimally invasive surgery, and that is what discourages a lot of surgeons not to learn that technique. We do use the C-arm x-ray quite often, at times four to six minutes a case, and that is a lot of radiation exposure in the life of the surgeon. Now we are adopting the robot in our technique for minimally invasive surgery which is helping us in many ways.

How accurate is the robot?

Dr. Zahrawi: The robot is very accurate. We take a CT scan of the operated area before surgery, the surgeon rehearses the procedure on the computer and designs the screw location and length. It gives the surgeon a chance a night before to think about his case and understand the problem much better before he faces it the next day in the operating room. That by itself can help avoid a lot of problems. The robot has a fraction of a millimeter accuracy. One very important benefit is that it cuts about 80% of the radiation exposure to the patient and surgeon.

How precise does the robot get?

Dr. Zahrawi: To a fraction of a millimeter.

How does that compare to free hand?

Dr. Zahrawi: The more inexperienced the surgeon and the more complex the case, the more the robot shines. While it is not as crucial in the hands of the experienced surgeon doing a standard case, it is a must in my opinion in the hands of the inexperienced surgeon on a complicated and large deformity case.

Talk about that procedure, how long did it take with the Mazor (Robot)?

Dr. Zahrawi: One of the advantages of minimally invasive spine surgery is takes actually less time in the experienced surgeon's hands than the standard procedure. What we are learning is that the robot can add to that, and the more we become familiar with it, the faster we get.

Now for example we can insert a four guide wire to advance the screws in less than four to five minutes, compared to eight to ten minutes in the free hand technique

And when it is there, does it guide you?

Dr. Zahrawi: Yes, as we are working and moving from one level to another the robot can alert you to a less than ideal screw position by turning the color to red. That means we must change the position on the screw. When it is in the correct position it turns green just like a stop light when driving. 

FOR MORE INFORMATION, PLEASE CONTACT:

Rachel Rognlin
Clinical Care Coordinator
Celebration Health Spine Center 
(407) 303-4545
www.celebrationspinecenter.com

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