Health September 12, 2016

Teaming with Technology

Robotic-guided, minimally invasive spine surgery provides patient benefits

When orthopedic spine surgeon David Verst, M.D., enters the operating room at St. Luke’s Wood River Medical Center (SLWRMC) to perform spinal surgery, he has a distinct advantage: he has already completed the surgery before he steps foot in the room—virtually, that is.

Dr. Verst, who is board certified in orthopedic surgery and is former chairman of orthopedic surgery at SLWRMC, now performs minimally invasive spine surgeries with the aid of the Mazor Robotics Renaissance Guidance System.

The robotic navigation system assists the surgeon by providing preoperative planning tools and robotic guidance during surgery. In the field of spinal surgery, where precision is paramount, the tool has been transformative.

“Hands down, this technology offers greater accuracy, efficiency, safety and better outcomes than traditional open surgeries,” Dr. Verst said.

Robot Redefined

In case you’re imagining an anthropomorphic robot-doctor hovering above the surgical table, getting a good picture of what the technology is—and is not—is a good first step in understanding how it works.

The state-of-the-art system is composed of two tools: specialized pre-planning software, which a surgeon can run on his laptop, and a small—about the size of a 12-ounce can—robot with an extending arm.

The technology assists the surgeon in the placement of pedicle screws—metal screws used to secure the vertebrae in the spinal column during minimally invasive spinal fusion surgery, biopsies, kyphoplasty and sacroiliac fusions.

The ultimate goal: p[ain relief and quality of life for patients.

“Spinal fusion surgery treats a patient’s mechanical pain resulting from a bulging disc or another deformity in the spine anatomy that is constantly pressing on a nerve,” said Amir Suidan, clinical sales manager for Mazor Robotics, developer of the technology.

Guiding, Not Replacing

At each stage of planning and surgery, the Renaissance technology guides and assists, but it never replaces the surgeon’s hand.

First, in advance of the surgery, the surgeon plans the procedure using the software, which uploads the patient’s CT scan to create a 3D model of his or her spine, allowing the surgeon to map out each step of the surgery and any necessary tools required in advance.

Traditionally, this planning would take place during surgery; the surgeon would make a large incision and, uncovering the joint, would use anatomical landmarks to decide where to put the screw at that time.

“With pre-planning using this technology, we know in advance exactly where the anatomy is and can avoid the large incision,” Dr. Verst said.

This is especially helpful in patients who may have had previous surgeries or injuries that have left scar tissue or have altered traditional anatomical landmarks, he noted.

During surgery, the robot is secured to a mount above the patient’s spine and guides the placement of the surgeon’s tools to precise vectors, according to the preoperative plan, merging the preoperative CT with real-time images that reflect the patient’s exact position on the table. Once the robot has identified the accurate location for the screw to be placed, the surgeon performs the actual procedure.

“The technology guides the placement, but the surgeon makes the skin cut and places the screw,” Dr. Verst said. “In no way does the robot take the place of the surgeon’s years of intellectual training and experience; it just augments what you’re doing.”

The benefits of the assisted, minimally invasive approach are significant.

“In the past, this type of surgery could be fraught with complications and risks—including blood loss, spinal cord and nerve damage, risk of infection and numerous X-rays during surgery,” Dr. Verst said. “With this technology, the efficiency, accuracy and precision all correlate to increased safety and better outcomes for patients.”

Why Here, Why Now?

Wood River Valley residents’ love for playing hard takes a toll on joints and discs in the back. The option to be treated for spinal conditions that require surgery in their own backyard with technology that allows for a quick recovery is ideal.

“What’s most important for patients in this Valley is to maintain quality of life—they want to still climb Baldy, mountain bike, and ski. The minimally invasive aspect is key in getting people back out doing the things they love,” Dr. Verst explained.

But it’s not only athletes and recreation lovers who are seeing the benefit.

“We do treat athletes experiencing symptoms from wear and tear, but probably 87 percent of my practice is outside the Valley—farmers and agricultural workers, people who have been doing manual labor all their lives,” Dr. Verst said. “The benefit to those folks is huge.”

And, the appeal of the surgery reaches far beyond the Valley and the state. As the only hospital in a five-state area to have the Renaissance system, Dr. Verst said, SLWRMC is drawing patients from Wyoming, Nevada, and California, among other places.

A Community Effort

While the benefits of this technology may be obvious to patients here and in surrounding regions, how this leading-edge technology found its way to SLWRMC, a small, rural hospital, is not.

So how did SLWRMC make it happen?

“What’s exciting about the effort to bring the Renaissance technology to St. Luke’s is that it was driven by our clinicians,” said Megan Thomas, chief development officer for St. Luke’s Wood River Foundation.

Several years ago, Thomas said, Dr. Verst and orthopedic surgeon Herb Alexander, M.D., recognized the value of navigational technologies and began to research a variety of potential systems.

“Drs. Verst and Alexander spearheaded the effort, and they ultimately settled on Mazor because it was the most appropriate for the types of surgeries we perform at our hospital,” Thomas said.

The next step: funding the technology.

What followed was a partnership between clinicians and the board of the St. Luke’s Wood River Foundation to bring the benefits of the system to the Valley.

“Our foundation board recognized the potential and jumped in to help make it happen,” Thomas said. The funds were raised through the foundation from a wide network of community support.

“This effort is indicative of the enduring commitment in our community to creating truly the best community hospital in the country,” Thomas said. “The consistency of support and generosity from our community is incredible.”

This article appears in the Fall 2016 Issue of Sun Valley Magazine.