Lending a Hand: Use of Robotic-Arm Enables Pinpoint Accuracy During Spine Surgery
Severe, ongoing back pain can be severely debilitating. Some conditions can affect one’s ability to walk or carry out basic activities. Just ask Amanda Murdolo. Last April, during the pandemic lockdown, the 22-year-old graduate student started experiencing lower back pain.
By the time she saw a doctor after the lockdown lifted, she could barely walk for 10 minutes without having to stop. Sometimes, the pain shot down her leg. “I couldn’t do much physical activity,” she recalls. “Simple tasks like standing and doing dishes became painful. At times it felt like someone was pulling both ends of the nerve in my left leg really tight.”
After seeing several doctors, Amanda, who lives in Bay Shore, Long Island, was referred to Darren R. Lebl, MD, MBA, a spine surgeon at Hospital for Special Surgery (HSS) who practices in both Manhattan and at HSS Long Island in Uniondale. Around the time she saw Dr. Lebl, he had just completed his 100th minimally invasive, robotic-assisted spine surgery.
The robotic system would be used in Amanda’s surgery to correct a spinal condition called spondylolisthesis, which causes one of the lower vertebrae of the spine to slip forward onto the bone directly beneath it. This was putting pressure on a nerve.
The first step for Amanda was a virtual visit with Dr. Lebl. After she felt comfortable talking to him remotely, she went to his office for an examination and for an explanation of her condition and what surgery would entail. He explained that he performed the procedure with assistance from robotic technology in the O.R., which allowed for an ultraprecise surgery.
“Over the past few years, advances in surgical technique and technology have enhanced the accuracy and predictability of spinal surgeries, and patients like Amanda benefit,” said Dr. Lebl. “Advances such as computer navigation, 3D imaging and robotic-assisted surgery have been tremendous in terms of allowing us to do less invasive, yet more precise surgeries.”
The use of very small incisions preserves muscles and other structures surrounding the spine, so patients generally experience less pain after surgery, a shorter hospital stay and a quicker return to activities compared to traditional open surgery, he explains.
Amanda had a spinal fusion in December 2020. “A vertabra in her lower spine had shifted or ‘slipped’ forward, causing impingement on a nerve root,” Dr. Lebl explained. “Through a minimally invasive technique, we were able to realign her spine and take the pressure off the nerve to relieve her pain.”
Dr. Lebl uses the robotic system to treat conditions such as Amanda’s, as well as a herniated disc, spinal stenosis or scoliosis. Prior to surgery, detailed images of the patient’s anatomy are obtained to plan and customize the procedure for each individual patient. Preoperative CT and MRI scans create a three-dimensional map of the patient’s spine that is used during surgery. Dr. Lebl performs the procedure with small incisions and robotic guidance, always maintaining full control. Visualization of the surgical field is provided by a computer console that displays the high-definition 3D image of the patient’s anatomy in real time.
Many spine surgeries, including Amanda’s, require the use of hardware such as titanium screws to stabilize the spine, and their accurate placement is critical to the success of the surgery. “The robotic arm, along with 3D imaging and navigation technology similar to GPS, allow for pinpoint accuracy in the placement of hardware, and this is a major advantage of the system,” Dr. Lebl says.
Amanda said the thought of having spine surgery was a frightening prospect, especially during the pandemic. It would be the first surgery she ever had, and she was worried about pain. But it was never an issue. “I was very surprised at how little pain I had after surgery,” she says. “The whole time in the hospital, I never had real pain, it was more like discomfort. The nurses would come in and ask, ‘What is your pain level on a scale of 1 to 10?,’ and for me it was ‘1 to 3.’ Everyone around me was very impressed with how quickly I recovered and how well I’m doing.”
Amanda had her surgery on a Friday and went home on Monday. Now, about six weeks after the procedure, pain-free, she goes to physical therapy and is back to her online classes as a full-time grad student. She is enrolled in a four-year program to receive a Doctor of Audiology degree and looks forward to the day in-person classes and her volunteer work in an audiology clinic can resume.
Dr. Lebl notes that the use of robotics in minimally invasive spine surgery requires special training and advises patients to choose a physician with ample experience in the technique. He also recommends that patients choose a surgeon with whom they feel comfortable and who takes the time to answer all their questions. When considering where to have surgery, hospitals that perform a high-volume of such procedures have been shown to have the best outcomes.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.