Virtua Health, southern New Jersey’s largest health system, has achieved another milestone in its robotic-surgery leadership. The Marlton, N.J.-based organization is the first in the Philadelphia region and South Jersey to provide robotic-assisted spine surgery combined with a GPS-like navigation system that enhances safety and enables better outcomes.

The navigation software, called Spine Guidance by Stryker, enables surgeons to create “safe zones” where the surgical tools can be blocked from entering, minimizing the risk of damage to surrounding structures.

“It’s the only software on the market that allows us to set up safe zones, which enables us to relieve pressure on compressed nerves more safely and efficiently,” said Dr. James Sanfilippo, vice president of clinical operations for musculoskeletal services at Virtua Health.

Robotic-assisted spine procedures are not widely available yet, and Virtua is one of the first in the country to offer them. The not-for-profit health system has been a leader in robotic surgery for 20-plus years, including hip and knee replacements, among other procedures.

“Our decades of experience performing other types of robotic-assisted orthopedic surgery have positioned us to readily embrace new forms of the technology as they’re introduced,” said Dr. Sanfilippo, who is also a spine surgeon with Virtua Reconstructive Orthopedics. “We work closely with robotic-device manufacturers, in this case Stryker, to ensure we can offer the best options to our patients across our region and beyond.”

He and his team use Stryker’s Mako Spine robotic surgery platform, in addition to its Spine Guidance software. 

Robotic-assisted spine surgery with Spine Guidance offers increased precision, which can optimize safety, help preserve healthy tissue, reduce the amount of cutting, and make recovery faster and easier, compared to other spine-surgery techniques.

The state-of-the-art technology is used for spinal fusion surgery, which joins the vertebrae (spine bones) together to stabilize injured spinal segments. Rods and screws are attached between the fused vertebrae to relieve pressure on compressed nerves and thereby reduce or eliminate pain and preserve a person’s mobility.

Potential to help millions

Spinal fusion is the most common surgery for chronic back and leg pain caused by trauma, spine deterioration due to aging, disc herniation, misaligned vertebrae, and other conditions. About 1.6 million spinal fusions are performed each year in the United States, according to Stryker.

Currently, 70% of pedicle screws (specialized implants used in spinal surgery) are placed with some type of navigation system, but only 10 - 15% are placed with robotics.

“It is likely that robotics can be used in at least 70% of spine fusion surgeries and, in my opinion, that number is actually higher,” said Dr. Sanfilippo.

The robotic system enables the surgeon to navigate tiny robotic tools with more exactitude than traditional methods. The surgeon directly controls a robotic arm and wrist that have a greater range of motion than the human hand.

“We’re extremely proud to offer this leading-edge technology, so we can help our patients recover better and more quickly from a range of debilitating spine conditions,” said Dr. Sanfilippo.

He and several Virtua colleagues have already performed over 300 procedures using the Spine Guidance software, including 75 cases using the Mako robotic arm, as well.

“The instruments are integrated into the navigation software, so the robotic system helps us position and control the instruments very precisely,” he explained. “It allows us to remove bones and ligaments off of nerves in the spine in a more precise fashion. It also allows us greater precision as we place the screws into the bones. It’s a safer and more efficient way of doing these surgeries.

“Our patients have had great success with robotic-assisted spine surgery,” added Dr. Sanfilippo. “It has reduced postoperative pain and complications by making the surgeries more minimally invasive and reducing some of the risks associated with freeing up the nerves.”

How the technology works

Robotic spine surgery builds on technology used for other types of robotic-assisted orthopedic surgery, such as hip and knee replacements. In fact, Virtua orthopedic and spine surgeons use the same robotic arm, which holds the instruments, for these various surgeries. The robotic spine-surgery instruments and the software used to plan and guide the surgery are designed specifically for spine surgery, Dr. Sanfilippo noted.

Prior to surgery, a CT scan of the patient’s spine is loaded into the system’s computer, and a second CT scan is done at the start of the procedure. The two scans are then merged, for increased accuracy. Using high-speed camera technology, the image is placed over the patient during the procedure, helping to guide the surgeon’s movements of the robotic arm and instruments via the computerized navigation system. (During traditional spine surgery, many x-rays are typically needed.)

The surgeon also views a second screen, which is attached to the camera focused on the surgical area. Additionally, an overhead monitor shows the patient throughout the procedure.

Special trackers on the patient and the surgical drill monitor all motion – including patient movement – and the surgeon knows where the drill is at all times in relation to the patient’s anatomy.

“The technology is almost like a back-up camera for your car,” said Dr. Sanfilippo. “It’s easier, we can see a wider field, and we can see how close we are to surrounding structures.”

Greater precision & protection

The software’s ability to set safe zones – areas that need to be avoided by the surgical instruments – is a vital feature.

“We can outline the spinal canal or openings where nerves come out of the spine, and how much space we want to leave,” he explained. “We can set the system to alert us or shut off the drill automatically if we reach a safe zone.”

This capability also helps surgeons operate more safely on certain high-risk patients: those with unusual anatomy, such as scoliosis (side-to-side curvature of the spine) or a tumor that has distorted bones or other tissue.

“The margins around the spinal cord are very small – half a millimeter – so the highest level of accuracy is needed,” Dr. Sanfilippo emphasized. “Robotic-assisted spine surgery with advanced navigation software gives us that capability, which leads to better outcomes for our patients.”

Robotic spine surgery is available at Virtua Voorhees Hospital and Virtua Mount Holly Hospital. It can be provided as same-day, outpatient surgery in many cases. For more information, visit go.virtua.org/dream-team or call 856-416-6679.