At Cedars-Sinai, surgeons have the option of employing additional tools in spinal fusion surgery. Neuronavigation, computer-assisted technology that assists in navigating the skull or spine during surgery, requires the use of an intraoperative 3D imaging system and can be used for traditional open surgery or minimally invasive methods.
Preoperative CT scans or intraoperative 3D can be registered to neuronavigation to give 3D guidance and real-time feedback to the surgeon. Coupled with anatomic landmarks and tactical feel, the 3D feedback provides surgeons with additional points of information to cross-reference throughout the procedure.
Cedars-Sinai surgeons can alternatively opt to use an advanced robot to support the placement of pedicle screws. Robotic systems assist the team in planning and mapping the surgery. The robot facilitates minimally invasive techniques, which have the potential to decrease tissue damage to the patient, Tuchman said.
Synced with neuronavigation, the robot maps the optimal placement and gives the surgeon a precise trajectory for placing the pedicle screws. The robot attaches to the patient’s spine at several bony prominences as reference points. Using pre-op and intraoperative imaging, it creates a 3D orientation. Next, the robot arm moves around to guide the surgeon in placing the pedicle screw.
"It’s one of the tools that helps us get good anchors to stabilize the spine," Tuchman said.
For the surgeon and team in the operating room, pairing use of the robot with pre-op imaging and neuronavigation systems can decrease radiation exposure by minimizing necessary intraoperative radiation.
While earlier surgical robots had limited communication and functionality, the model Cedars-Sinai currently uses is compatible with other devices, allowing for more pre-op planning and real-time visualization.