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Types of Cases for Robotics

In general, the board-certified neurosurgeons and orthopedic spine surgeons at CNSO use robotics for two commonly performed surgeries, minimally invasive surgeries and spinal deformity surgeries. Both are suited to the use of these enabling technologies due to the nature of the need for precise implant placement and the surgeons wish to do the same surgeries as before without making large incisions and exposing the spinal structures such as muscles and facet joints in order to visualize the underlying bones. It has been proven that, while necessary in some surgeries, minimizing the exposure of these tissues can lead to less postoperative pain, lower infection rates, quicker return to normal function, and decreased risk of breakdown of the adjacent levels as the spine itself is a complicated structure with many moving parts.

Minimally invasive spine (MIS) surgery has become more and more popular over the past 10 years due to advances in technology that have made it better and more effective, as well as the improvements in patient outcomes especially in the first few months after surgery when they are trying to return to work and physical activity. Instead of using larger incisions down the middle of the spine which require moving and damaging all of the muscles that attach there, in MIS surgery, smaller 1-2 cm incisions can be made off the sides of the spine to place stabilizing screws and rods as well as to remove pressure from the spinal nerves and place implants in the disc space if needed (anterior, lateral, or posterior interbody fusion). Robotics and navigation allow CNSO surgeons to place these implants and decompress the spinal nerves through small incisions and accomplish even more accurate placement despite the fact that the muscles are not moved out of the way, and recovery is faster in most cases. Through preoperative planning software, the surgeons at CNSO can plan ideal trajectories of the implants to minimize incision size, allow easier passage of the rods and interbody cages, and even place implants in small or difficult to access pedicles without the need to open the spine and directly visualize those structures. In addition, it is possible to do “front and back” surgeries that were traditionally done through different positions requiring positioning the patient on their back or side and then moving them during surgery to “single position” surgery now which decreases operative time and therefore risk of certain complications.

Preoperative planning using CT scan uploaded to robotic platform (Image Courtesy of Globus, Inc).

Spinal deformity surgery to correct problems such as scoliosis in children and adults and kyphosis or “flat back syndrome” after previous spine surgery are also ideal indications for robotic and navigation and allow the CNSO surgeons to perform these operations with even greater accuracy and benefit to the patient. Each patient is evaluated by both an orthopedic and neurosurgical spinal deformity specialist to deliver a team approach to these complex problems and decide on the very best operative plan before surgery is undertaken. Either before or during surgery, the necessary CT scan is taken and used to formulate a precise surgical plan including placement of screws, osteotomies (removal of bone in order to “loosen” parts of the spine) and allow greater corrections of deformities, and allow our surgeons to optimize the correction of each patient’s deformity. One of the greatest benefits of this technology is the ability to place implants more precisely in small or “dysmorphic” pedicles, as well as creating new screw tracts in bones that already contained implants in a suboptimal position, which can be very difficult to accomplish with the traditional “freehand” techniques or with x-ray alone. As a greater number of surgical levels are performed, the radiation to the patient is reduced as only one x-ray at the beginning of the surgery is usually needed rather than multiple x-rays each time a screw is placed. The neurosurgeons and orthopedic spine surgeons at CNSO are highly trained and skilled in the use of these techniques and are proud to offer this technology to our patients throughout the northern New Jersey area.

Images show before and after images of transforaminal lumbar interbody fusion (TLIF) done using robotic guidance with restoration of normal alignment.

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