In the last two decades, medical technology as it pertains to spine surgery has been innovative and effective for patients with chronic back pain. One of the latest advances in surgical intervention has been the use of robotic-assisted technology.
The Mazor X Stealth Edition
™, a robotic surgical assistant, is one such tool that optimizes spine surgeries, making them faster and more precise for the surgeon while saving time on patient recovery.
Dr. Richard V. Chua
The device provides surgeons 3D visualization, allowing them to see a more accurate view of the problematic area in the spine. This helps with surgical accuracy and planning. The surgeon tells the robot where it wants the instrumentation to be placed and the robot executes the plan using stereotactic navigation. It’s like punching coordinates on your car’s GPS.
Dr. Richard V. Chua, MD, FAANS, FACS
, a neurosurgeon based in Tucson, Arizona, with Northwest Medical Center
, was one of the first surgeons to embrace the technology and use it during his spine surgeries. Northwest Medical Center was the first in Arizona, and one of the earliest in the country, to acquire and use this specific technology. To date, he’s performed nearly 100 procedures using the technology. He first came across the technology eight years ago when it was in its infancy. Chua says the technology wasn’t ready for prime time then, but once he heard Mazor X merged with industry leader Medtronic, he had confidence the product would improve.
“When I heard that there was a merger between those companies, I knew that there were significant improvements that had occurred with the technology,” he said.
He reached out to Medtronic, and they invited him to a training on using the improved system.
“I went to a cadaver training program for surgeons, learned about the advancements in the technology, got to fiddle around and practice with the robot,” Chua said. “I spoke with the engineers, spoke with the sales folks, and then realized that it was at least worth a conversation with our hospital to acquire the technology.”
What sold Chua on Mazor X Stealth Edition this time was its improved software, its robotic and image guidance technology, and the robotic assistant itself.
“There was a significant improvement in the instrumentation that the robot is attached to and how the robot is attached to the patient,” said Chua. “So, in 2018 when we acquired what I consider the third-generation robotic technology, we knew that within six months we would have the latest and greatest fourth generation technology—the Mazor X Stealth Edition.”
Convinced that Northwest Medical Center should be among the first to use the technology, he pitched the idea to the surgeons and administration at the hospital.
New technology can be expensive, but Dr. Chua believed the advantages such as shorter hospitalizations, fewer complications including nerve injuries, and fewer returns to the operating room were worth the added cost. “With new and enabling technologies, you have to justify and weight the advantages over the disadvantages, including the cost of the technology,” he said.
Since its computer-based robotics, Mazor X Stealth Edition comes with a learning curve. Chua said it’s not as significant as one might imagine, given that he believes surgeons will ultimately prefer this robot’s ability to expedite surgeries with additional accuracy.
“Once the learning curve is achieved, then the time to do the surgery is not only time net neutral but may be more efficient and a faster operation or a shorter operation,” he said.
Chua says the Mazor X Stealth Edition robot-assisted surgery technology helps him in three ways: pre-surgical planning, surgical accuracy, and reducing the patient, surgeon, and operating room staff exposure to x-rays used during the surgery. Here’s how he explained each:
“Number one, it has a computer software program to allow me to do the planning of the operation from the skin incision location and size to the size and configuration and alignment of the screws we place into the patient. And it allows me to do all of that planning prior to the surgery before I even step into the operating room.
“It takes that planning software and that plan that's integrated into the robot and it matches it to the patient in the operating room with just two simple X-ray pictures. That registration process allows the highest accuracy of the robot helping me place the screws. It improves the accuracy of placing screws for fusion operations in the lower back. And the more accurate we are at placing screws, the less risk we have of nerve injury, bone not healing, which is called a pseudarthrosis, pain, and infection.
“As part of the accuracy, the robot executes the plan while providing real time three-dimensional image guidance verification of me placing the screw exactly in how I had planned it additionally improving the accuracy of placing the screws,” he said.
“The accurate execution of the plan with real-time image guidance verification allows us to do the surgery with much fewer x-rays to verify that we are placing the screws safely. This is beneficial for not only the patient, but the surgeon and the operating room staff,” he said.
One of Dr. Chua’s patients is Alan Petrillo, a 71-year-old freelance journalist. He came to Dr. Chua with a synovial cyst from his joint and it was causing spinal stenosis and compression of a nerve associated with spinal instability.
Petrillo had been avoiding surgery for over two years, instead relying on conservative treatments for his pain.
“I was seeing an orthopedic surgeon, and they start you out with a course of PT and then I went through some spinal injections,” said Petrillo.
While that temporarily resolved his pain, his back condition worsened.
“It got worse or moved somehow onto the nerve and it wasn't letting go and so it took me the better part of a year to suffering through the pain, taking ibuprofen and a little bit of opioids, which I disliked doing, cause they distort your life, basically. And, but I was reluctant to mess around with my back. That kind of surgery is not something you look forward to,” he said.
His wife, who worked at Dr. Chua's practice several years prior, suggested he consult with Dr. Chua about spine surgery.
“I was experiencing an awful lot of pain and to the point where I was starting to drag my leg and have a different gait,” he said. “I made an appointment, and he had me get a CT scan and X-rays and he laid out my options for me.”
Petrillo chose surgery and Dr. Chua shared that he would use the Mazor X Stealth Edition to assist.
“He had told me all the benefits of this new machine and how he felt confident that it would be a big help in my surgery,” said Petrillo.
After his spine surgery, he was back on his feet after six weeks. Under Chua’s instructions he had to keep it light post-op until his back could heal.
“I'm a gym rat and so I wasn't allowed to go to the gym [for the first six weeks]. No bending, lifting or twisting. No lifting, nothing more than a half-gallon of milk,” Petrillo recalls. “I was putting in two, three miles a day walking because it was the only exercise that I was allowed to do.”
After three months, he was able to resume his normal life again and is pleased with the outcome of the surgery and regrets putting it off for so long.
“I wish I had done it a year earlier, but I can't say enough good things about Dr. Chula and his robot,” he said.
That’s a sentiment Chua loves to hear from his Mazor X Stealth Edition patients.
“That means more to me than anything when people say, ‘I wish I had done it earlier because as the surgery and recovery was not as bad as I thought it would be or I had a better result than I thought it would be.’ I love hearing that,” said Dr. Chua.
Updated: May 18, 2020