If too much of bone/joint/ligaments need to be removed to adequatelydecompress the nerves in the lumbo-sacral spine, the strength and stability ofthe spine might be hampered. In such situations, screws are inserted in thevertebral bodies and connected to rods to restore strength/stability to the spine.In addition, cages filled with bone graft are placed between the vertebral bodiesin order to fuse one to the other over time, thus buttressing the screws-rods inplace.
Screws are also required if X-rays in flexion/extension reveal instability in thelumbo-sacral spine which creates a situation called Lumbar Spondylolisthesis.
The traditional method of placing screws in the spine is by a large midlineincision. Through the midline, first the nerves are decompressed. Thereafter,the muscles are significantly retracted to the sides and screws are placed in thevertebral bodies and connected to rods. Finally, cages filled with bone graft areplaced 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 theLumbo-sacral spine is termed Open Pedicle Screw Placement.
Dr Sanyal has stopped placing Open Pedicle Screws since 2010 because he findslarge midline incisions and retraction of the muscles to the sides grotesque inthis era and age. He has placed every screw since 2010 percutaneously throughtiny stab incisions. He uses meticulous pre-operative planning to ensure exactplacement of the screws. Such meticulous pre-operative planning helps exactplacement of percutaneous pedicle screws without expensive gadgets such asNeuronavigation/O-arm. A small midline incision is used to relieve pressure onthe 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-operativeplanning of the percutaneous pedicle screws on the pre-operative CT images andreplicate the location of the tiny skin incisions and the angles of placement of thepercutaneous pedicle screws intraoperatively by means of intraoperative Xrays.With the advent of Robotic guidance in Spine Surgery, Dr Sanyal has adapted RoboticSpine Surgery into his practice.
After anaesthesia and positioning of the patient, Dr Sanyal uses an O-arm whichgenerates an intra-operative 3D CT scan of the spine. Thereafter, he does theplanning 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 ArtificialIntelligence to swing into the exact position and the exact angle for placement ofthe percutaneous pedicle screws which are performed through the robotic arm.To further ensure perfect placement of the screws, intraoperative Neuronavigation isused.
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.
