Dr Sujoy Sanyal is one of India’s as well as the world’s pioneering Spine Neurosurgeons in the field of Minimally Invasive Spine Surgery (MISS) or Minimal Access Spine Surgery (MASS). Dr Sanyal has not placed any open pedicle screws in the spine since 2010.
If too much of bone/joint/ligaments need to be removed to adequately decompress the nerves in the lumbo-sacral spine, the strength and stability of the spine might be hampered. In such situations, screws are inserted in the vertebral bodies and connected to rods to restore strength/stability to the spine. In addition, cages filled with bone graft are placed between the vertebral bodies in order to fuse one to the other over time, thus buttressing the screws-rods in place.
Screws are also required if X-rays in flexion/extension reveal instability in the lumbo-sacral spine which creates a situation called Lumbar Spondylolisthesis.
The traditional method of placing screws in the spine is by a large midline incision. Through the midline, first the nerves are decompressed. Thereafter, the muscles are significantly retracted to the sides and screws are placed in the vertebral bodies and connected to rods. Finally, cages filled with bone graft are placed between the vertebral bodies in order to fuse one to the other over time, thus buttressing the screws-rods in place. This method of placing Screws in the Lumbo-sacral spine is termed Open Pedicle Screw Placement.
Dr Sanyal has stopped placing Open Pedicle Screws since 2010 because he finds large midline incisions and retraction of the muscles to the sides grotesque in this era and age. He has placed every screw since 2010 percutaneously through tiny stab incisions. He uses meticulous pre-operative planning to ensure exact placement of the screws. Such meticulous pre-operative planning helps exact placement of percutaneous pedicle screws without expensive gadgets such as Neuronavigation/O-arm. A small midline incision is used to relieve pressure on the nerves and all necessary screws are placed through tiny stab incisions.
Prior to the advent of Robotic Spine Surgery, Dr Sanyal used to do the pre-operative planning of the percutaneous pedicle screws on the pre-operative CT images and replicate the location of the tiny skin incisions and the angles of placement of the percutaneous pedicle screws intraoperatively by means of intraoperative Xrays.
With the advent of Robotic guidance in Spine Surgery, Dr Sanyal has adapted Robotic Spine Surgery into his practice.
After anaesthesia and positioning of the patient, Dr Sanyal uses an O-arm which generates an intra-operative 3D CT scan of the spine. Thereafter, he does the planning of the percutaneous pedicle screws on the CT images generated intraoperatively by means of the O-arm.
The Robotic Arm uses the pre-operative planning of Dr Sanyal and Artificial Intelligence to swing into the exact position and the exact angle for placement of the percutaneous pedicle screws which are performed through the robotic arm. To further ensure perfect placement of the screws, intraoperative Neuronavigation is used.
Dr Sanyal had already been placing Percutaneous Pedicle screws since 2010 through tiny stab incisions. Robotic Spine Surgery has decreased the size of the incisions a little bit more.
The biggest advantage of Robotic Spine Surgery, in Dr Sanyal’s opinion, is decrease in radiation exposure both for the patient as well as for the healthcare personnel and decrease in operative time (because intraoperative xrays are no longer required).
Decrease in size of skin incisions, lesser muscle retraction and shorter operative time translate into a faster successful post-operative recovery.
