Dr. Anthony Leone recently underwent back surgery. After performing more than 50 minimally invasive spine surgeries himself, it was easy to decide that he would have bone spurs removed from some of his spinal disks in a similar way.
“Twenty years I’ve been doing surgery and for 18 years I did the big incision like everybody else,” said Leone, who does his procedures at Sisters Hospital – St. Joseph Campus in Cheektowaga. “The first time I did the new surgery, I looked at my physician assistant and said, ‘I’m never going to do one of those other surgeries again.’ ”
Leone is one of two spine surgeons in the region who have begun using computer and robotic help to perform procedures designed to remove, repair and fuse spinal disks. He began using the Mazor Robotics’ Renaissance Surgical Guidance System late last year at St. Joe’s.
Dr. John Pollina, medical director of Spine Services at Buffalo General Medical Center, recently started using a similar Mazor X surgical assurance platform on the Buffalo Niagara Medical Campus.
Mazor guidance technology couples a CT scan taken in the days before the procedure and X-rays once in the operating room that allows doctors to create a “surgical blueprint” of a patient’s spine before surgery. The system then helps guide the surgeon’s hands and instruments to pre-planned locations.
“This robotic technology allows for unparalleled accuracy and safety in spinal surgery, leading to better results for our patients,” Pollina said.
Each system cost their hospital groups about $1 million. The systems allow the surgeon to make a smaller incision in the back to get to the spine – 1.5 inches versus up to 7 inches for more conventional surgery. Thin tubing that can carry surgical instruments and special lighting allows doctors to use screws, rods and cages to bolster the spine. Surgeons use magnifying lenses to work; they and their team can monitor progress on a computer screen.
The process creates more precision. It reduces blood loss, muscle damage and post-surgical pain. It speeds recovery.
Leone talked about the Mazor system he uses.
Q. Why is the recovery time faster?
When you do the big surgery and make the midline incision, you’re stripping all the muscle off the spine, off the joints, and that’s how you put the screws in under direct vision. You do the nerve decompression under direct vision. Once that muscle is stripped off the spine like that, you have a great view, but that muscle is never going to function the same again. ... It’s been 10 months now with the minimally invasive surgery but when I see a patient going home a day after surgery, it’s still something I don’t take for granted. Usually a day after surgery when somebody has that big incision, it’s difficult enough to get them to roll over so you can look at the incision. Now, you walk in the room and they’re walking around.
Q. What did you prescribe for pain management with more traditional surgery than this?
With multilevel fusions, we might have to use Oxycodone or something stronger. Now we have them down to hydrocodone or Percocet, which are still opioids but not as strong. A lot of times, they’ve been taking these before surgery. ... The nice thing is that within three weeks, they’re not taking anything; some Tylenol maybe. It’s nice to have them off the pain medicine sooner.
Q. Is anyone who needs back surgery a good candidate for this type of surgery?
If somebody’s recommending surgery to you, for 95 percent of the people I’ve seen, the surgery can be done this way. It can be done with one small incision from behind. You can get the cage in there, support the anterior column.
Q. Are their similar systems out there?
There are other systems and they’re similar in that they help with the guidance of the pedicle screws to make sure they’re put in accurately. ... They all have their merits. It’s what you’re comfortable with.
I just saw a report published in July in one of the journals that because you’re putting the screw in under robotic guidance, you can center it and really get a good-sized screw in that gets good grip in the pedicle (bone stub). Sometimes you might put a smaller screw in because you’re not sure you’re exactly 100 percent centered. Now we have studies that suggest that by having that kind of compact in the pedicle that it does less damage to the disks above and below the fusion. It lessens the damage of adjacent segment wear.
Q. What do you recommend for the recovery process?
We tell patients that the first thing they should do after leaving the hospital is they should be walking. You’re using your back muscles to hold you upright and you’re using your legs to ambulate. You’re working the back muscles and the leg muscles, which is exactly what we want. For the first four to six weeks, that’s pretty much all we’ll have them do. In the younger, more ambitious patients, we’ll have them do exercises to strengthen their legs but as far as any back movement exercises, we don’t do anything like that for a while, until that fusion is really solid. Then we can have them do abdominal strengthening, extensive strengthening and exercises to strengthen the spine and the chord.
Q. You recently had bone spurs removed from your spine that were pinching nerves and causing serious leg pain. You say now you have a better sense of what patients go through?
I had back pain, leg pain and surgery. I’ve had the whole gamut of what my patients go through and I can understand and empathize and sympathize with them 100 percent. That pain, for a lack of a better word, sucks. It’s very unpleasant and can literally incapacitate you.
Twitter: @BNrefresh, @ScottBScanlon