Unfortunately, the human spine is prone to many degenerative and traumatic conditions that can cause debilitating pain, loss of function, and severe reductions in quality of life. Although some spinal conditions can be treated non-invasively, sometimes surgery is the only answer. For many spinal conditions, a surgical fusion or fixation employing screws and rods can relieve the pain, allow for complication-free healing, and restore function and quality of life. Placement of these screws using the Mazor Robotic screw fixation system can speed recovery after the procedure and reduce the complication rate to near zero due to its precision and accuracy.
Surgical spinal screw fixation can be used to treat a wide variety of conditions, such as:
- Degenerative disc diseases
- Spinal stenosis
The most common indication for spinal fusion using screws is degenerative joint disease. The discs between the vertebrae that act as shock absorbers can rupture or wear out, causing two vertebrae to rub directly against each other, which can lead to excruciating pain during even the most minor movements. During a spinal fusion surgery, the affected vertebral bones are subjected to treatments that will cause them to fuse to each other during the healing process. Once healed, the fused bones will eventually stabilize the affected region of the spine, eliminating pain and improving function and quality of life. However, in order to stabilize the bones during the bone healing process, metal screws and rods need to be placed in the bones along with bone graft materials. Depending on the positioning of the screws, they may be referred to as pedicle or facet screws.
Mazor Robotic screw fixation is also used to treat other conditions, such as spinal deformities (scoliosis) that develop during childhood or during the aging process. Screws and rods may need to be placed to stabilize the spine into a more normal configuration, with or without the need for bone fusion between various vertebrae. After a traumatic incident like a car accident, Mazor Robotic screw fixation may be necessary to stabilize the spine in order to prevent paralysis during the bone healing process. After surgical treatment of other conditions, like tumors or stenosis, the spine may also need to be stabilized by Mazor Robotic screw fixation while it heals.
Although surgery in the past always involved “opening up” the patient, open surgery causes trauma, tissue damage, scarring, and a prolonged recovery time. Thus, the trend in surgery today is to use minimally-invasive techniques where special instruments are inserted to allow the surgical procedure to be performed with minimal damage to the tissues. Such procedures have very short recovery times and lead to minimal scarring. One technical innovation in performing minimally-invasive procedures is the development of robotic equipment that assists the surgeon in performing the procedure to further reduce its invasiveness and to improve patient outcomes. Another advantage of these robotic systems is making the surgery easier for the surgical team. Complicated minimally-invasive surgeries that do not use robotic systems can be very difficult for surgeons to perform, leading to inconsistent results among patients. Robotic systems make these surgeries more intuitive and easier to perform, and provide excellent visualization of the surgical field. Thus, surgeons can rapidly learn how to perform them and provide excellent patient results each and every time.
A Closer Look at Mazor Robotics
The Mazor Renaissance System is a robotic system specially designed to perform spinal surgeries. It has sophisticated imaging systems that allow the surgeon to plan the surgery in great detail, to monitor the exact positioning of the tissues and bones during the surgery, and to precisely guide the instruments to perform the procedure. One unique aspect of the system is that it uses biocompatible devices to firmly attach the robotic instruments to the patient’s bones during the procedure, allowing for extremely accurate anatomical placement of incisions, bone grafts, and screws. This precision allows for highly reproducible excellent patient outcomes and a quick recovery time.
The first step is to obtain an accurate diagnosis of the patient’s condition. This is usually accomplished by taking a medical history, performing a physical examination, and getting detailed images of the patient’s spine by CT and/or MRI, or in some cases, PET/CT.
After diagnosing the underlying structural problem causing the patient’s symptoms and concluding that a spinal fusion involving screw fixation is the optimal treatment approach, the next step in Mazor Robotic screw fixation involves uploading CT scans of the patient’s spine into the Mazor System. Then, it uses its sophisticated 3D virtual environment software platform to assist the surgeon in planning the surgery and to select the proper screw size and type, the necessary bone graft type and material, and any other surgical tools that may be necessary. The system allows for viewing the site from many different angles and perspectives in order to come up with a surgical approach that will result in the best outcomes for each individual patient.
Attachment and Synchronization
After the plan has been developed, the next step is the surgery. The patient is anesthetized, and then the robotic instrument platform is skillfully attached to the spine in order to ensure maximal accuracy and precision using the special Mazor biocompatible attachment devices. Then, two fluoroscopic images are taken and matched to the pre-operative CT scan in the robot’s operating system. Each vertebrae is recognized in the images by the software regardless of patient movement or changes in intervertebral spaces during the procedure in order to ensure maximal precision in placing the screws.
Next, tiny incisions are made to access the vertebrae being fused, and the robotic system assists the surgeon in guiding the instruments with accuracy to place any necessary bone grafting materials and to insert the screws and rods to stabilize the spine during the healing process. After placement of the screws, the instruments are withdrawn, the mounting platform is removed, and the tiny incisions are closed. In some cases, they are small enough to not even require suture placement. If for some reason during the operation the surgeon needs to convert from a minimally-invasive procedure to an open procedure, the Mazor Robotic System can be left in place and be used to guide the subsequent open procedure.
Recovery from the actual surgical procedure usually only takes days, but the spine needs to be carefully protected for multiple weeks while the bone graft heals into place and fuses the spine. Thus, bending, twisting, and all vigorous physical activities need to be avoided during this period of time. Lifting any objects that weigh more than around eight pounds is forbidden. Careful planning before the surgery to arrange the house to avoid any need for lifting and bending by placing objects on countertops and so forth can make recovery a breeze. Arranging for help before the surgery in regards to housework, yardwork, and child care is essential. Recovering individuals can usually manage to care for themselves in regards to ambulation, dressing, hygiene and other activities of daily living.
The screws themselves are tiny screws made out of bio and MRI-compatible material, either stainless steel or titanium alloys in most cases. They are designed to co-exist peacefully with the human body and to not interfere with medical scanning such as MRI and CT. They are screwed into the vertebrae and provide attachment points for rods. The screws are placed in the vertebrae on either side of the section to be fused by using what is essentially a small, sterile power screwdriver. Then, the rods are attached to the screws spanning the region to be fused to hold it motionless during the healing process.
The Bone Graft
In addition to screws and rods, in practically all cases, a bone graft is placed to mediate the fusion process. Bone grafts come in various forms. In some cases, a small piece of bone taken from the patient or a cadaver source is simply placed between the vertebrae to encourage bone to grow between them and fuse them together. If there is a large gap between the bones, an intact piece of bone can be placed in addition to or instead of the bone in order to encourage proper fusion of the vertebrae. Although a bone graft from the patient is the best, due to the disadvantages of trying to harvest bone from the patient (an additional surgical site is necessary, and often a large amount of bone is required and cannot be obtained from the patient without causing serious damage), bone graft banks have been set up where cadaver bone material from donors is prepared, sterilized, tested, and maintained until needed by someone else. These bone grafts are completely safe and do not transmit infection or require immunosuppression to prevent rejection. In addition, artificial and enhanced materials have been developed for use as bone grafts; these materials may come in putty or gel form and may contain molecules like bone morphogenetic protein that accelerate growth of bone in order to encourage the fusion to heal faster.
Do the Screws Need to Be Removed?
After the healing process is complete, if necessary, the screws and rods can be removed in a second procedure. However, surgeons generally recommend leaving them in place permanently to ensure the spine remains stably supported across the fusion. A small percentage of patients may decide to have them removed in a simple, minimally-invasive surgery with a very short recovery time.
If you or a loved one is suffering from a back problem, consider making an appointment at Subach Spinal Solutions to discuss whether or not Mazor Robotic screw fixation is right for you. Contact us today to book your consultation at our office in Arlington, VA!