|WRITTEN BY KRISTI RUNYON|
|MONDAY, 28 MARCH 2011 10:54|
miniature robot gives surgeons more precision when they straighten crooked spines from scoliosis.
When viewed from behind, the spine normally aligns in a straight line. In a person with scoliosis, the spine curves from side to side, looking more like the shape of a “C” or “S.” This twisting of the spinal column can also make one hip or shoulder appear higher than the other.
According to the National Scoliosis Foundation, about 2 to 3 percent of people in the U.S. have scoliosis. The most common type is adolescent idiopathic scoliosis. The cause is unknown, but the condition can run in families. Girls are affected more often than boys. Diagnosis is typically made when the child is between 11 and 17.
The danger with scoliosis is that the abnormal curves can continue to progress, or get worse. This can cause pain, difficulty with movement, breathing problems, and, in serious cases, significant disfigurement. For an unknown reason, scoliosis curves are more likely to progress in girls than in boys.
There are several different treatment options for scoliosis, depending upon the age of the child, degree of curvature and the anticipated rate of curve progression. For small curves, or for children with moderate curves who have stopped growing, doctors may simply monitor the child periodically to watch for curve growth.
Children with spinal curves of 25 to 30 degrees who are still growing may need to wear a brace. The device provides a strong system of support for the spine and aims to prevent the curves from getting worse. It is usually worn for 16 to 23 hours a day until the child stops growing or doctors believe the spinal curves are no longer progressing.
Patients who are still growing and have a curve of more than 45 degrees may be recommended for surgery. Doctors often fuse two or vertebrae to straighten the spine (spinal fusion). Screws, rods and other hardware are also used to stabilize the spine and hold it in place. The National Scoliosis Foundation estimates 38,000 spinal fusions are performed each year for scoliosis.
With the trend moving toward smaller incisions and minimally invasive surgery, spinal surgeons must do a considerable amount of preoperative planning and have greater technical expertise. Some surgeons are getting help from SpineAssist®. Though it’s considered to be a type of surgical robot, it only helps with placement planning, leaving doctors to perform the actual procedure.
The SpineAssist consists of two main components: a workstation and a robotic arm. Prior to surgery, CT scans are taken of the spine. Working from 3D images, the surgeon can simulate the placement of implants, as well as the size, angle and depth of the hardware. Once the best approach is determined, the information is saved in the computer.
On the day of surgery, the prepared plan is loaded into the SpineAssist workstation. The robotic arm is mounted onto a platform and placed securely on the back. More images are taken of the spine. The computer uses these images to map the coordinates of the robotic arm against the patient’s anatomy, then matches these with the images in the surgery plan. The SpineAssist device positions the robotic arm in the proper trajectory for the target location of the implant. The surgeon then drills into the bone and secures the hardware.
Dennis Devito, M.D., Pediatric Orthopedic Surgeon with Children’s Healthcare of Atlanta, says the SpineAssist enables him to thoroughly review the patient’s anatomy, determine potential obstacles, then plan and practice the surgery before he gets in the operating room. And with the guidance of the robotic arm, placement of the implants is more accurate.
For information about SpineAssist®, go to:
For information on scoliosis:
National Institute of Arthritis and Musculoskeletal and Skin Diseases, http://www.niams.nih.gov
National Scoliosis Foundation, http://www.scoliosis.org
North American Spine Society, http://www.knowyourback.org
Scoliosis Association, http://www.scoliosis-assoc.org
Scoliosis Research Society, http://www.srs.org/patients
Barzilay, Y., et al., “Miniature Robotic Guidance for Spine Surgery,” International Journal of Medical Robotics, June 2006, Vol. 2, No. 2, pp. 146-153.
Busscher, Iris, et al., “Predicting Growth and Curve Progression in the Individual Patients with Adolescent Idiopathic Scoliosis,” BMC Musculoskeletal Disorders, May 17, 2010, Vol. 11, p. 93.
Devito, D., et al., “Clinical Acceptance and Accuracy Assessment of Spinal Implants Guided with SpineAssist Surgical Robot,” Spine, November 15, 2010, Vol. 35, No. 24, pp. 2109-2115.
Lieberman, I., et al., “Bone-Mounted Miniature Robotic Guidance for Pedicle Screw and Translaminar Facet Screw Placement,” Neurosurgery, September 2006, Vol. 59, No. 3, pp. 641-650.
Yang, Xiaoming, et al., “Clinical and Radiographic Outcomes of the Treatment of Adolescent Idiopathic Scoliosis with Segmental Pedicle Screws and Combined Local Autograft and Allograft Bone for Spinal Fusion,” BMC Musculoskeletal Disorders, July 14, 2010, Vol. 11, p. 159.
Research compiled and edited by Barbara J. Fister