Single Position Lateral Spine Fusion Surgery – What’s the Big Deal?

On Friday 20th July the Sydney Morning Herald published an article relating to a case that I performed at The Valley Private Hospital in Melbourne a few weeks ago.

The case was novel in the sense that I was able to utilise the Mazor Renaissance Spine Guidance Robot to place pedicle screw fixation with the patient in the lateral position. This was the first case that the ProLat system had been used in Australasia.

The patient initially had 2 levels of OLIF interbody cages placed in the mid lumbar spine to manage a degenerate scoliosis and stenosis problem that was causing considerable pain and dysfunction for the patient. Pedicle screws are routinely placed to stabilise the spinal segments after placing interbody cages so that the correction is maintained and healing rates improved.

Traditionally during surgery, patients would be transferred off the operating table and then returned in the face down (prone) position to allow screws to be placed. This is the usual position that surgeons are familiar with and the guidance systems have been developed for this position.

The ProLat system allows rigid mounting of the Mazor Renaissance Robot so that surgeons can have the benefit of the accuracy of this system, and avoid the potential errors that might occur by operating with the patient in an unfamiliar position.

I have been using the Mazor Renaissance system for nearly 2 years and have become very familiar with its application for placing pedicle screws. I see that it has major advances when screws are placed percutaneously or in cases of complex deformity.

I have also been working to integrate the Mazor with the intraoperative CT scanning equipment available at the Valley Private. To be able to ‘scan and plan’ on the operating table eliminates the X-ray registration process that can sometimes lead to delays in the operation. Scan and plan is inherently highly accurate due to the increased detail obtained with CT axial imaging. This was the first use of ‘scan and plan’ integrated with the Mazor /Prolat system. For me it just made sense to take this natural next step.

One drawback of using this technology can be the added time that it takes to set up and the requirement for repositioning or ‘flipping’ the patient during the case. With the use of ProLat the surgeon can ‘skip the flip’ and continue with the fixation by pedicle screws immediately following the lateral or OLIF interbody surgery. This can lead to surgery time savings and operating room efficiencies as well as importantly reducing anaesthetic exposure times for patients.

Surgeons have been striving to achieve single position lateral surgery for a long time and with this combination of technology I am confident we have achieved something significant. Surgeons can now be confident in performing complex surgery with a high degree of accuracy and so minimising complications at the same time as achieving more efficient use of operating room time.

Acknowledgement is given to Life Healthcare and the Valley Private Hospital for making this technology available for this case and working collaboratively to achieve this milestone.