Tech & Health: Spine surgery goes high-tech

SURGERY MEETS ROBOTICS: HS Chhabra, medical director and chief of spine services, Indian Spinal Injuries Centre

Poor lifestyle, stressful living and probably genetic conditions are making spinal ailments and deformities more common than before. Also, India records an alarmingly high number cases of spinal trauma and spinal tumours every year. However, operating on a spine is one of the most challenging surgeries a surgeon can attempt.

HS Chhabra, a renowned orthopaedic spine surgeon and medical director cum chief of spine services at New Delhi-based Indian Spinal Injuries Centre (ISIC) explains the daunting task: “As the body’s central support structure, the spine has 31 pairs of spinal nerves—8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal, and each pair connects the spinal cord with a specific region of the body. When combined with other common surgical and post-surgical complications, one can imagine the immense risk of a spine surgery.”

Thanks to evolving technology and engineering capabilites, minimally invasive spine surgeries are becoming safer and more precise than ever. With the advent of the robotics method, Chhabra says that spine surgery has become better in terms of patient outcomes. “Spine Robotics interface with O-arm is the most recent advancement that can help surgeons before and during the surgery and improve results and accuracy for patients causing lesser pain, promoting faster recovery and reducing the risk of a revision surgery,” he says.

What is O-arm?
The O-arm, with its patented design, provides true 360 degrees 3-D imaging during the course of spine surgeries. It is optimised for the requirements of spine and orthopedic surgeries, considerably reducing the chances of a revision surgery. O-arm not only provides real-time, intraoperative imaging of a patient’s anatomy with high definition but also a large field-of-view in both two and three dimensions. The retractable O-arm can internally rotate around the patient on an operating table in 360-degrees with 6-degrees freedom, taking a 2D or 3D image of the area to be operated. Thus, the surgeon can visualise the patient’s anatomy from any desired angle.

Going beyond high-definition real-time imaging, O-arm has other workflow benefits which make the surgeon’s job easier, reduce stress in the OT and improve confidence. “First, with robotic positioning system operation theatre personnel can use O-arm just like the traditional practice of a C-arm, thus making it very easy for the surgical team,” says the top surgeon at ISIC. “Second, the imaging time is just 13 seconds. Further with the choice of varying dosage modes, O-arm enables the most optimised dose without compromising on image quality. Lastly, O-arm is fully mobile and can be easily moved from one operating room to another for concurrent use.”

Why O-arm and robotics at ISIC?
“Owing to ISIC’s reputation, we get a lot more complicated and revision cases as compared to a typical multi-specialty hospital. Also, our spine surgery volumes are quite high,” says Chhabra. He explains that the moment there is any complication, the imaging needs to go up. While the typical pre-operation CT helps in diagnosis, this image is taken with the patient facing up and the surgery is usually performed with the patient facing down or sideways. As a result, even in simple complications, there is anatomical shift, that is, the relative position of anatomical structures as seen in pre-operation CT is not the same as during the surgery. This can make the job of a surgeon more difficult.

“This is where engineering and technology solves the problem: O-arm with Mazor X S.E. Robotic system,” he stresses.
Basically, O-Arm when combined with the Mazor Robotic system leads to ecosystem benefits. The two technologies are designed to work together seamlessly. As a result, the image taken from O-Arm can be transferred to the robotic system at the click of a button and the patient registration process is automatic. This not only saves time but also removes chances of manual error. Further, as the image is taken intra-operatively, the relative position of anatomical structures in the image is same as in the patient on the table.

“With this image an experienced surgical team can quickly make the most optimum plan using advanced planning capabilities of the robotic system, execute this plan with robotic precision all the while visualising with navigation features of Mazor X S.E. robotic system,” he explains. “Finally, with O-arm we can take a confirmatory scan just before finishing the surgery. The position memory functionality enables us to robotically manoeuvre O-arm to the same position at the touch of a button to reconfirm implant position. As a result, we don’t need to wait for a post-op CT-scan to confirm the surgical goals. If any correction is needed, the same can be done in the same surgery, potentially avoiding revision surgery.”

Surgery with O-arm robotics is a huge step-up not only in improving patient outcomes in regular surgeries, but also in complex deformity surgeries, cervical spine surgeries, protecting vital vessels in neck and many other complex spinal procedures.