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UC Irvine doctors perform West Coast’s first robotic surgery on spine

Technology increases precision, enhances healing and improves results

April 11, 2011

UC Irvine Medical Center’s Dr. Nitin Bhatia and Dr. Samuel Bederman have conducted the first robot-assisted spinal surgery on the West Coast.

They utilized a robotics system called SpineAssist to increase the precision of spinal implant placement in a Los Angeles woman who had undergone two previous operations, including a spinal fusion in 2007 to treat a degenerative disk. She had developed another herniated disk in her lower back that caused pain and sciatica. The goal of the SpineAssist procedure—a spinal fusion performed with screws and grafts—was to alleviate her discomfort and stabilize the spine.

“We expect this technology to improve outcomes, shorten surgical times and enhance healing in our spinal surgery patients,” said Bhatia, UC Irvine’s chief of orthopaedic spine surgery. “The system allows us to preplan an operation using CT scans to precisely plot the surgery and program the robot to guide screws in exactly the right spot in the patient’s spine.”

SpineAssist is designed to guide the surgeon, with help from a robotic arm, in placing the pedicle screws employed in spinal stabilization. A 2010 study in the journal Spine showed that it can increase the accuracy of spinal implants by up to 98.3 percent and significantly lower the rates of misplaced screws and subsequent neurological problems.

Used several times now at UC Irvine, the system also lessens radiation exposure for the patient, surgeon and entire operating-room team. Traditionally, spine surgeons must take dozens of X-rays during a procedure to ensure that each screw is properly located and doesn’t impinge on nerves or breach the spinal canal. Since the robot is programmed based on scans prior to an operation, the physician can work more quickly, with greater precision and fewer X-ray fluoroscope images.

“Our surgical outcomes are already excellent, so I’m always skeptical when a new technology claims it can improve these results,” said Bhatia. “This technology, however, surpassed our goals for all of our patients. We have successfully treated problems such as spinal stenosis, spondylolisthesis and scoliosis using these robotic techniques.”

Within a day of her March 15 operation, Lourdes Medina, 32, was walking around her hospital room. “I feel 100 percent better,” she said. “Before, there was excruciating pain radiating down my leg and I couldn’t sleep. Now there’s no pain in my legs or hips for the first time in a long time.”

Bederman, an expert in scoliosis and spinal deformity, said that – besides common degenerative problems requiring spinal fusion – the robot could help address spinal alignment problems, which generally fall into three categories: congenital or developmental issues, like scoliosis in children; deformities that develop in adulthood associated with arthritis, fractures or tumors; and those resulting from previous spinal surgery.

The UC Irvine spine team also sees a role for the robot in revising spinal fusion surgeries of aging baby boomers. In recent decades, spinal fusions have increased threefold, and it’s likely that many will require revision as arthritis weakens the spine near the fusion site, spinal tumors develop or spinal injuries occur.

“UC Irvine is a pioneer in robotic surgery, and the addition of SpineAssist will dramatically enhance our comprehensive robotic offerings,” said Dr. Ralph V. Clayman, professor of urology and dean of UC Irvine's School of Medicine. “Robotic surgery offers significant benefits over conventional surgery, and the university’s investment in advanced robotic technologies underscores our commitment to clinical excellence and successful patient outcomes.”

In 2002, UC Irvine was Orange County’s first medical center—and among the first on the West Coast—to employ the da Vinci Surgical System. Dr. Thomas Ahlering has become a world leader in robotic prostate surgery and removal, with more than 1,000 prostatectomies since da Vinci’s introduction. In 2010, Dr. Jason Kim became the first surgeon in the West to take out a thyroid with the robot, and UC Irvine established the country’s first Robotic Oncology Center, which seeks to harness robotic technology to create better results for cancer patients.

About UC Irvine Medical Center: Orange County’s only university hospital, UC Irvine Medical Center offers acute- and general-care services at its new, 482,000-square-foot UC Irvine Douglas Hospital and is home to the county’s only Level I trauma center, American College of Surgeons-verified regional burn center and National Cancer Institute-designated comprehensive cancer center. U.S. News & World Report has included UC Irvine for 10 consecutive years on its list of America’s Best Hospitals, giving special recognition to its urology, gynecology, and ear, nose & throat programs.