a. 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.
b. Screws are also required if X-rays in flexion/extension reveal instability in the
lumbo-sacral spine which creates a situation called Lumbar Spondylolisthesis.
a. Traditional Open Pedicle Screw Placement
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.
b. Minimal Access Percutaneous 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 intra-
operatively 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.
