Spine surgeons from University of Maryland Orthopaedics have a new helper in the surgical suite. The latest robotic technology is the new standard for complex spine surgery, enabling surgeons to place pedicle screws used to attach spinal segments to a rod with better-than-ever accuracy, lessening complications and the potential need for a repeat surgery.

"There's never been a sector in any industry where a robot has not enhanced it," says Steven Ludwig, MD, professor of orthopaedics and division head of orthopaedic spine surgery at the University of Maryland School of Medicine. The robot doesn't necessarily make really excellent surgeons even better, but it allows them to do things more efficiently and to avoid potentially preventable complications that can occur even in the best of hands.

University of Maryland Medical Center (UMMC) is the only hospital in Maryland to perform complex thoracolumbar and pelvic reconstruction with a robot. The innovative technology is utilized for uber-complex cases, such as spinal deformities, significant spine arthritis, spinal trauma, and spinal tumors, in adult and pediatric patients.

The robot can be used for open, as well as minimally invasive procedures. Patient benefits include a speedier recovery, shorter hospital stay, less post-surgical pain, lower infection risk, and reduced risk of injury to tissue and muscle. Additional advantages are minimized radiation exposure for everyone in the operating room, and enhanced visibility for surgeons.

Before robotic surgery, physicians could only estimate the width and length of the screws needed. Now, a preoperative CT scan of the patient's spine is completed and the results are fed into the robot's computer. The software then helps surgeons determine the precise screw size and trajectory. The software also assists with determining the correction needed to improve spine alignment. As a means of predefining the operative plan, a 3-D model of the patient's spine is built. While on the operating table, a mounting platform for the robot is attached to the patient's spine, and two fluoroscopic scans are performed. Through a process called registration, the robot matches the vertebrae on the X-rays to those on the CT scan and signals where to place the screws.

"There are a lot of danger zones near where we operate," says Dr. Ludwig. In particular, surgeons must vigilant to avoid harming the spinal cord, nerve root and blood vessels. Being off by just a few millimeters could potentially create a devastating problem. "Place a screw too medially or too close to the nerve root or spinal cord, and the patient might end up in worse pain or paralyzed. Place it too laterally, and it might break loose from the vertebra." Studies estimate the accuracy of robot-assisted surgery at more than 99 percent, better than standard techniques.

UM orthopaedic surgeons are board certified, fellowship-trained and Shock Trauma credentialed. As part of an academic medical center, they are heavily involved in research and teaching in addition to clinical care.

Robotic spine surgeries are performed at UMMC, however consults and post-op visits are scheduled at convenient practice locations around Maryland. Call 410-448-6400 to refer a patient, or visit umortho.org to learn more.

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