In the recent past, people needing spine surgery underwent traditional open procedures, meaning neurosurgeons or orthopedic surgeons made a five-to-six-inch-long incision in the back that allowed access to the relevant area. Although this method allowed the surgeon to easily view the spine, it also involved retracting muscle and surrounding soft tissue. The invasive nature of such procedures meant patients often remained in the hospital for a week after surgery, and total recovery sometimes took months.

WILSON “ZACH” RAY, MD, AND SURGICAL TEAM, USE A ROBOTIC SYSTEM WITH CONTINUOUS X-RAY IMAGING THAT ENHANCES PRECISION IN SPINE SURGERY. Photo courtesy of Barnes-Jewish Hospital

Recent advances in minimally invasive technology have made open surgeries unnecessary for some treatments and some qualified candidates. Using specialized instruments and working through small incisions, spinal surgeons are able to make repairs while reducing hospital stays and shortening recovery time. And now, a primary advantage of open versus minimally invasive surgery—a clear view of the surgical site—has been addressed with the advent of robotic navigation systems.

To date, these systems are being used to help neurosurgeons and orthopedic surgeons precisely place spinal screws, though future applications could include decompression of spinal nerves and repairing damage caused by spinal cancer.

The device works by merging a previously taken CT scan of the patient’s spine with images produced during surgery using fluoroscopy, a technology that makes it possible to show a continuous X-ray image on a viewing monitor. Wilson “Zack” Ray, MD, Washington University neurosurgeon at Barnes-Jewish Hospital, says, “We end up with a map of the spine that is based on the patient’s exact anatomy. The navigation system then maneuvers a robotic arm into precise, programmed positions.”

Minimally invasive spine surgery is used to repair spinal fractures, to enhance spinal stabilization and to repair damage caused by spinal tumors, among other treatments. Prior to the development of the robotic navigation system, surgeons relied on their experience and on two-dimensional X-rays to help them determine where to place spinal screws. Rays says, “We took multiple X-rays during surgery to ensure proper placement.” The navigation system has eliminated that need, thereby adding another benefit to the list of advantages in some minimally invasive spinal treatments: reduced exposure to radiation.

Deeptee Jain, MD, Washington University orthopedic surgeon at Barnes-Jewish Hospital, notes: “Although some people might not be candidates because of their particular physiology, minimally invasive surgery is our first choice whenever possible.”