Robotic technology is gaining traction in the spine surgery field, allowing surgeons to pre-plan and customize procedures to fit an individual's anatomy.
In a Mazor Robotics-sponsored webinar, Dennis P. Devito, MD, Children's Healthcare of Atlanta spine program director, and Kornelis Poelstra, MD, PhD, of Miramar, Fla.-based Sacred Heart Hospital on the Emerald Coast, discussed their experiences using Mazor Robotics technology during spine surgeries.
"Robotics are here to stay and are really going to help us," said Dr. Poelstra, who has already performed 92 Mazor X cases to date.
Although Dr. Devito relied on freehand technique for the majority of his career, Dr. Devito began using robotic technology in 2006, to "add a dimension of safety and precision" to pedicle screw implantation during spinal surgery.
The United States has 70 hospitals actively using Mazor Robotics technology with 113 centers globally, and 16,000 cases have been performed worldwide.
Dr. Devito's clinical evidence
Dr. Devito and his colleagues at Children's Healthcare of Atlanta (CHOA) prospectively collected data on cases using robotic-guided technology.
From 2007 to 2011, 120 adolescent scoliosis cases were reviewed, with the goal of assessing the value of image-based robotic guidance. Specifically, they examined how the technology contributes to safety as a preoperative planning tool. Additionally, Dr. Devito assessed the technology's accuracy and reproducibility.
- Out of 1,779 placed screws, Dr. Devito's team found an overall accuracy rate of 99.65 percent.
- Additionally, the team reported no neurological complications or postoperative revisions.
Initial critics of this data theorized that results were not necessarily reproducible, or that positive results were influenced less by the technology's ability and more so by contributions of OR staff and post-operative care. To investigate this possibility, Dr. Devito's team began a multicenter study.
Among five additional centers using Mazor Robotics technology, the researchers maintained a 99.3 percent accuracy rate. Additionally, the study an average screw placement time of 4.5 minutes, inclusive of setup, registration and execution using the guidance system. This data was presented at the 2014 International Meeting on Advanced Spine Techniques.
More recently, Dr. Devito and his team compared their first 120 reviewed cases between 2006 and 2011 to their last 50 cases between 2015 and 2016. They found a further 38-minute reduction in total case time, and a decrease of 50 percent in fluoroscopy exposure, resulting in an average fluoroscopy time of about 0.5 seconds per screw.
Dr. Poelstra's clinical evidence
In a paper presented at 2016 International Meeting on Advanced Spine Techniques, Dr. Poelstra and his team conducted a retrospective four-surgeon study comparing robotic MIS (with the Mazor Robotics Renaissance® Guidance System), freehand MIS and freehand open.
When comparing robotic-guided MIS to freehand MIS, robotic MIS resulted in:
- Fewer surgical complications
- Fewer revision surgeries
- Less intraoperative fluoroscopy use
When comparing robotic-guided MIS to freehand open, robotic MIS resulted in:
- Fewer surgical complications
- Less intraoperative fluoroscopy use
Advantages of robotics
During the course of the webinar, both panelist surgeons advanced many benefits for spine surgery facilitated by the use of this kind of technology:
- Enhanced intraoperative efficiency and accuracy
- Plan screw cadence and skin incisions for facilitating rod insertion
- Helps focus on the overall surgical correction as opposed to just the challenges of implant insertion
- Recognition of abnormal or challenging anatomy prior to entering the OR
- Safety in the form of reduced fluoroscopic radiation
- Reproducibility
- Surgeon efficiency
- Better patient outcomes
"I've really uncovered the three-dimensional anatomy of spinal deformity," said Dr. Devito. "It's unpredictable based only on X-rays…The software allows you to be more prepared for your cases as you've seen it prior to going to the operating room, so you don't waste time in the OR trying to get a screw in a very abnormal pedicle."
Dr. Poelstra agreed, noting better planning and virtual execution will enhance outcomes.
Dr. Devito also countered the occasional argument that suggests robotic technology worsens a surgeon's freehand skills, arguing that surgeons who pre-plan cases will enhance their skills because they better understand the three-dimensional anatomy.
"I think robotic-assisted spine surgery has passed the inflection point of clinical effectiveness," said Dr. Devito.
"If we embrace and collaborate on this together, utilizing robotics, I think we eventually will be able to say that this will redefine the standard of how spine surgery is going to be done," said Dr. Poelstra.
The future — Mazor X
Opening the door to the future, the Mazor X platform expands on Mazor's robotic guidance technology to include analytical tools, multiple-source data, precision guidance, optical tracking, intraoperative verification and connectivity technologies.
A Mazor X pioneer, Dr. Poelstra has already performed 92 cases with the technology. The technology has allowed Dr. Poelstra to perform "very safe, reproducible spine surgeries," placing 2,078 screws with 100 percent accuracy. Dr. Poelstra said robotics will eventually extend beyond the spine, aiding in soft tissue manipulation for decompression and fusion disc preparation.
"We're working on refining the workflow for [the Mazor X], but I believe it's going to give us better reach and better trajectory ranges for screw insertion," said Dr. Devito. "I'm hoping too, the future unfolds more active robotic tools as Mazor X becomes more widely used."
Listen to the webinar recording here. View Dr. Dennis P. Devito's webinar slides here and Dr. Kornelis Poelstra's webinar slides here.