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Robot Revolution - Robotic Surgical Guidance Platform for Spine Surgery

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Robot Revolution - Robotic Surgical Guidance Platform for Spine Surgery

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By CeCe Noland

NURS 5324 Healthcare Informatics
University of Texas at Tyler
Dr. Jerri Post, PhD, RN
Fall 2021

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Please visit this link to watch a short video and to find more information regarding the Mazor X Surgical Guidance System.

Source: Medtronic, January 2021

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The Confidence of Access and Interbody Navigation

Navigate with ease - and precision:

Visualize the reach of disc prep instruments and precise placement without intraoperative fluoroscopy.

Use Elevate™, Capstone™, and Clydesdale™ systems for confident posterior and lateral interbody placement.

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Navigate with ease - and precision: Visualize the reach of disc prep instruments and precise placement without intraoperative fluoroscopy. Use Elevate™, Capstone™, and Clydesdale™ systems for confident posterior and lateral interbody placement.

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The Mazor X Surgical Guidance System was first introduced in October of 2016 at the North American Spine Society annual meeting in Boston, Massachusetts.  It is the third generation of the technology following Mazor Spine Assist (first generation) and the Mazor Renaissance (second generation).

The platform allows spine surgeons to utilize pre-op imaging (CT scan) to plan and customize their patients' implants, identify challenging anatomy, and address almost every aspect of the procedure before their patient ever steps foot in the operating room.  That plan is then merged with the patients intra-operative imaging allowing the surgeon to implement using robotic guidance.

In 2019, Medtronic released Mazor X Stealth Edition (MXSE), a major advancement in the technology. Prior to the release of MXSE, robotics and navigation stood apart as two separate technologies. By integrating them together, surgeons get the advanced and near limit-less application of robotics with the confirmation and feedback of navigation.

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Fan, Y., Du, J., Zhang, J., Liu, S., Xue, X., Huang, Y., Zhang, J., & Hao, D.  (2017).  Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery.  Medical Science Monitor, 23, 5960-5968.  DOI: 10.12659/MSM.905713

Kaminski, J. (2011). Diffusion of innovation theory. Canadian Journal of Nursing Informatics, 6(2). http://cjni.net/journal/?p=1444

Medtronic.  (2021, January).  Explore the latest Mazor Robotic Guidance innovations.  https://www.medtronic.com/us-en/c/spinal-orthopaedics/mazor-robotics-innovation.html?cmpid=PPC_Goog_Q1_OrthoSpine_H1_MazorRoboticGuidance_H2_RequestInfo_H3_TheStrength_D1_ExploreTheLatest_D2_LearnWhatStrength_ORT_SPINE_FY22&ef_id=CjwKCAjw-sqKBhBjEiwAVaQ9a7689vDDjzNrqBO-h8wsl4PaeJDua2eiJW3OA6f43ucvwN3pnzX9KhoC-T8QAvD_BwE:G:s&s_kwcid=AL!5660!3!537712539737!e!!g!!mazor%20x%20robot!14174172466!127212034002

Medtronic.  (2021, July).  Mazor X Stealth Edition Robotic Guidance System for Spinal Surgery.  https://www.medtronic.
com/us-en/healthcare-professionals/products/spinal-orthopaedic/spine-robotics/mazor-x-stealth-edition.html

Schröder, M.L. & Staartjes, V.E.  (2017).  Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis.  Neurosurgical Focus, 42 (5).  DOI: 10.3171/2017.3.FOCUS16534

Seicean, A., Alan, N., Seicean, S., Neuhauser, D., Benzel, E., & Weil, R.  (2014).  Surgeon specialty and outcomes after elective spine surgery.  Spine, 39 (19), 1605-1613.  DOI: 10.1097/BRS.0000000000000489

Thomson, Simon.  (2013).  Failed back surgery syndrome – definition, epidemiology and demographics.

British Journal of Pain, 7(1), 56–59.  https://dx.doi.org/10.1177%2F2049463713479096

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Improved implant accuracy over traditional methods.

Less radiation exposure for the patient, surgeon, and OR staff.

Ability to pre-operatively plan the entire procedure from screw and interbody placement, to location of skin incisions.

Improved workflow efficiency (surgery is planned days or weeks in advance).

Ease of executing minimally invasive approach (resulting in less bloodloss and decreased length of stay).

Decrease in revision surgeries associated with misplaced spinal implants (revisions are not only bad for the patient, but very expensive for hospitals).

(Fan et al., 2017)
(Schröder & Staartjes, 2017)

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The technology is in it's relative infancy which results in several issues: limited application; software bugs; technical and mechanical performance issues.

There is a learning curve associated with successful adoption of the technology.

To take advantage of pre-operative planning, a CT scan is necessary (not typically utilized by all spine surgeons consistently).

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I was very motivated by this assignment because I have worked in the medical robotics space for the last 6.5 years.  We refer to these types of innovations as 'disruptive technology' due to the way it completely upends and transforms the market it enters, very similar to the introduction of the iphone or self-driving cars.  With any disruptive technology, the introduction and adoption follow the Diffusion of Innovation Theory, which specifies the stages of adoption: innovators, early adopters, early majority, late majority, and laggards (Kaminski, 2011).  At present, robotic guidance platforms for spine surgery are in the early majority stage.

This innovaton truly has the potential, if used correctly, to transform the standard of care for the better.  This is important because elective spine surgery has some of the most variable patient outcomes in elective surgeries.  One study estimated the failure rate of spine surgery to be between 10-46% (Thomson, 2013).  A patient’s outcomes can even be affected by whether their spine surgeon is an orthopedic spine surgeon versus a neurosurgeon (Seicean et al., 2014).  This technology has the ability to produce more consistent and reproducible outcomes for spine surgeons and their patients.

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My top strengths as described in the Strengths Finder Assessment and how they would benefit a team:

Adaptability - Flexibility with strategy is necessary when working with new and disruptive technology.

Competition - A competitive spirit is necessary to advance the technology and get it past the early stages of adoption towards majority phase.

Includer - By including others' perspectives, we gain a wider of understanding of what it takes to achieve success.

Intellection - An appreciation and enjoyment of overcoming challenges is helpful in disruptive tech as it is often an uphill battle to adoption.

Input - The ability to acquire and retain new knowledge and experiences makes working in disruptive tech more rewarding personally and professionally.

Teams
In a team, I would be looking for the following qualities:

William Woo (influencing) - One of hardest parts of achieving successful adoption is getting the early adopters on board.  The first stage, innovators, usually don't need a lot of convincing.  But getting the early adopters and early majority on board takes work from influential people.

Sheila Strategic - Strategic people are necessary to help the team stay on track and to pivot to a new strategy when necessary.

Matthew Maximizer - These individuals are necessary in new technology and innovations to keep pushing the needle of advancement forward and avoid complacency.

Faith Futuristic - These people keep driving the team toward the vision and goals for the future.

Alice Achiever - These people are the foot soldiers, on the ground driving adoption.