Spine Center adopts robotic technology

May 12, 2022
a group of people in surgical garments gather around a computer screen while behind them a patient lays on the table with an x-ray machine shaped like an "o" encircling the table
Dr. Bruce Frankel, pointing at screen, plans his approach to the surgery after the patient was scanned by the O-Arm mobile X-ray machine while in the operating room. Photos by Sarah Pack

Lying in her hospital bed in an operating room as staff bustled about, preparing for the surgery, the patient quietly teased the doctor: “Have you got all your toys?”

He did, he assured her. Her surgery was to be the first at MUSC Health-Charleston Division using the Mazor X Stealth robotic system and Medtronic O-arm mobile X-ray machine. But those “toys” are more than shiny new playthings for surgeons. Neurosurgeon Bruce Frankel, M.D., believes they will enable the doctors in his division to continue to innovate and improve surgeries for patients, moving MUSC Health to the very cutting edge of spinal surgery offerings.

The patient was clearly in pain, wincing as the anesthesia team lowered the head of the bed as gently as possible. The surgery, a microdiscectomy, was to address that pain. It’s a common procedure to deal with a herniated disc within the spinal column that’s pressing on nerves, causing sciatica.

It is not commonly performed with the Mazor X, however. Although the robotic system wasn’t designed with a discectomy in mind, Frankel wanted to see whether the system’s imaging and navigation capabilities could allow for more precision when performing this surgery.

“This is how you challenge yourself to adopt a newer technology to improve an older surgery,” he said.

a surgeon holds two long, skinny cylindrical steel instruments before inserting them into a port 
Dr. Bruce Frankel prepares to begin surgery. The robot is positioned to ensure the instruments are inserted at the correct angle. 

While robotic surgery has become almost commonplace in other specialties, it’s still very new in the field of spinal surgery. In the past few years, some studies comparing robotic surgeries to traditional methods indicate that common spinal surgeries performed with robotic assistance could result in more accurate screw placement, less blood loss and even shorter hospital stays for those surgeries that require hospitalization. But techniques and protocols are still developing as surgeons explore the possibilities with different companies’ robotic systems that have been introduced in recent years.

Doctors in the Neurosurgery and Orthopedic Surgery practice at MUSC Health examined five such systems and reported their findings to hospital leadership. Although MUSC has a value-based health care partnership with Medtronic, which owns Mazor, the partnership didn't drive the decision to pursue the Mazor system – quality did. However, now that the health system has acquired two of the Mazor X Stealth robots, there are opportunities to pursue innovation within the framework of the partnership, said Caroline Brown, chief external affairs officer.

Part of that innovation will occur at the MUSC Shawn Jenkins Children’s Hospital, which will become the first pediatric hospital in South Carolina to have the Mazor X Stealth robot.

“We are excited to announce the implementation of this advanced technology for the most complex pediatric spinal deformity patients,” said Robert Murphy, M.D., the chief of pediatric orthopedics. “We can provide the safest and most up-to-date orthopedic surgical care for children and adolescents with spine deformity and related spine conditions.”

After completing his first Mazor X surgery – which went well, with the patient going home that same day – Frankel said he expects he’ll continue to use it for discectomies, with a few adaptations.

“It gives you this accuracy that you didn’t have before,” he said.

The system works by taking images of the spine and then mapping the images to the patient on the table. This allows the surgeon to program the robotic arm to insert a port at a precise angle and location. Previously, Frankel said, accomplishing this required multiple X-rays as he went through each step of the surgery.

the screen shows the x-ray of the spine and the correct path for instruments 
Brad Morrison, senior Mazor robotic trainer, left, and Salley Carson, spinal robot consultant with Mazor assigned to MUSC Health, assist with the robot setup during the surgery. 

"This is constant fluoroscopy,” he said, referencing real-time moving X-rays. “It could be several minutes of it in complicated cases. Whereas with this, it’s one spin of the O-arm. This decreases the fluoroscopy time, which is better for the health of the patient and the health of everyone in that room who’s getting radiated, too.”

Frankel went on to perform a transforaminal lumbar interbody fusion – a fusion of two vertebrae – using the Mazor X. In the coming months, he’ll use the system for the majority of his surgeries. He expects that, as he comes to understand the strengths and limitations of the system, he’ll probably settle at using it for about three-quarters of his cases.

“This system, with its imaging, navigation and robotic assistance capabilities, will allow us to further refine the surgeries we offer at the Spine Center and improve patients’ experiences in the hospital and their recoveries at home,” he said.