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“The technology is among the most advanced systems available. The robot proved quicker and more precise than any experienced surgeon performing a standard spinal fusion. The patient was able to be discharged home same day with almost no pain following surgery, assisted with continuous pain infusion for up to 3 days” said Dr. Kadimcherla, a renowned spinal surgeon noted for his expertise in endoscopic and minimally invasive spine surgery.
He and his colleague, Kaixuan Liu, MD, performed the robotic operation at their center’s Advanced Spine and Outpatient Surgery facility.
Spine fusion is intended to stabilize and strengthen a spine that has been compromised by conditions like a herniated disc, spinal tumor, or compressed nerve, which can cause debilitating, chronic pain. The operation involves permanently connecting (fusing) two vertebrae in the spine after removing the diseased or damaged material from in-between them.
Dr. Kadimcherla and his colleague Dr. Kaixuan Liu MD, PhD used the ExcelsiusGPS®, which was developed by Globus Medical, to relieve pain in a 57-year-old patient suffering from a collapsed disc in his lower back and a bone spur impinging on a sciatic nerve. Medical images of the diseased area were imported into the ExcelsiusGPS® software, which then provided the surgeons with an anatomical plan that displayed on a screen and provided a GPS-like mapping system to guide a robotic arm with pinpoint accuracy.
Through small incisions, the two surgeons first inserted an endoscope, a long, narrow tube, equipped with a 3-D camera, to remove the herniated disc material and, in its place, load a tiny, expandable titanium cage with bone material to fill the void. The endoscope’s camera is comparable to a magnifier placed inside the spinal area. It enables surgeons to see the smallest anatomical details. Using the robot arm, Drs. Kadimcherla and Liu then positioned four screws in the spine to stabilize it.
“Insertion of the screws typically takes as long as an hour, but, with the robot, we completed the procedure in under 10 minutes,” Dr. Kadimcherla said. Globus Medical data indicate that the ExcelsiusGPS® system decreases overall procedure time by more than 50 percent.
“Our patient was able to go home immediately after surgery without the intense pain that normally follows this kind of spinal fusion and avoid a costly, extended hospital stay,” Dr. Kadimcherla added.
Dr. Kadimcherla agreed, stating that “this latest technology enables procedures to be performed more quickly through smaller incisions and with less muscle and soft tissue damage. For the patient, such efficiency means lower risk of postoperative infection, minimal blood loss, less dependency on pain medications, improved cosmetic results due to the limited size of the surgical cuts, and a quicker return to everyday activities. The system also reduces radiation exposure for both patient and surgeon.”
Recent studies of the ExcelsiusGPS® support such comments. Scientists writing in a 2018 issue of the Chinese Neurosurgical Journal reported that the ExcelsiusGPS® appears to have “several technological advances over prior spine robots and allows for precise execution of an intended pre-planned trajectory and accurate screw placement” in the spine.
In an article published in February 2021 in Frontiers in Surgery, authors argue that early clinical results show robotic systems offering “equivalent accuracy and decreased radiation exposure compared with other methods of [spinal] screw placement.” They add that a high degree of accuracy in the insertion of screws in the spine is critical because “screw malposition may lead to serious complications, such as neurologic or vascular injury.”
Although robotics in general is not new technology, the ExcelsiusGPS® represents a major step forward, Dr. Kadimcherla said. “It keeps our Atlantic Spine Center on the cutting edge of advancements and novel applications in spinal surgery.”
Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. www.atlanticspinecenter.
Praveen Kadimcherla, MD, is a board-certified orthopedic spine surgeon and Medical Director at Atlantic Spine Center.
Kaixuan Liu, MD, PhD, is a board-certified, fellowship-trained, world-renowned minimally invasive endoscopic spine surgeon who founded the Atlantic Spine Center and the Advanced Spine Surgery Center, based in New Jersey and New York.
