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Surgical robot for spine surgeries now resides in Plano
Kim Williams / Staff Photo - Tressa Scott's spine at a 60 percent curve prior to surgery and less than a year ago.
The SpineAssist is one of three surgical robots in the United States and the only one in Texas. It is the only surgical robot designed specifically to operate on the spine. With more than 1,200 surgeries performed worldwide, about 300 are in the U.S. – all with no instances of nerve damage as a result of surgery.
The technology is new to Plano but has been on the drawing board for more than a decade, according to Dr. Isador Lieberman, a fellowship-trained orthopedic and spinal surgeon on the medical staff at the Texas Back Institute and Texas Health Presbyterian Hospital Plano. He worked on the idea of robotic spinal surgery originally and ended up partnering with Technion University in Israel to perfect the technology.
“A lot of times, we thought this is not going anywhere,” Lieberman said, “and then all the technology came together as the software became more advanced.”
The robot is basically a workstation that enables surgeons to pre-plan procedures in 3D based on the patient’s individual anatomy – creating a surgical blueprint – and a robotic arm that guides the surgeon during the procedure using the preoperative plan.
During surgery, the robot’s extension arm guides the surgeon to the pre-planned location, allowing the surgeon to operate through small incisions in the skin and underlying muscles in order to reach the exact location on the spine.
The procedures with SpineAssist are minimally invasive most of time; but when doctors perform spine surgery, there is always a margin of error allowed, even though the patient hopes for the best. The technology co-designed by Lieberman reduces that margin from an estimated 3 millimeters to one-half millimeter, which allows greater accuracy and enables surgeons to plan the surgery ahead of time using a computed tomography – imaging by sections – in a 3D simulation of the patient’s spine.
“The idea is to put screws in the back in a more precise manner,” Lieberman said. “The unit is precise because it is a more refined tool.”
Lieberman gives an analogy to explain how it works.
“Like a pilot in a flight simulator, I can map out the patient’s spinal anatomy and perform the entire procedure before the patient even arrives for surgery,” he said. “It allows me to be more efficient and more precise and to anticipate potential complications before they occur.”
The SpineAssist technology can be used in biopsies, to treat thoracic-lumbar fusion and vertebral compression fractures, and to correct scoliosis; it is the latest in advanced spine and orthopedic services. In addition to increasing precision, it reduces the amount of radiation exposure during surgery, which can reduce infection and pain after surgery, give fewer complications, allow a shorter hospital stay and result in a quicker recovery for patients.
“We are thrilled to be among the pioneers to adopt this leading-edge technology,” said Sara Misuraca, program director of the Scoliosis & Spine Tumor Center at Texas Health Plano. “We envision this technology as ushering a new era in spine surgeries, the same way laparoscopies transformed general surgery in the 1990s.”
Now that Lieberman and the SpineAssist have moved to Plano, Texas Back Institute and Texas Health Plano will be the new training center for physicians learning how to use the device.
“We are setting the standard and redefining how you do surgery,” Lieberman said. “We are even developing other platforms for orthopedic surgeries.”
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Scoliosis affects adults younger than 19, and can be extremely debilitating if allowed to continue to curve the spine.
Fifteen-year-old Tressa Scott of Allen had a large growth spurt over the span of a year. As she grew taller, she wasn’t able to stand up straight. Besides growing more than 1 inch, she gained a dramatically straighter spine after undergoing a complex spinal surgery by Dr. Lieberman with SpineAssist.
Tressa’s mother, Norma Scott, said she first noticed that her daughter’s scoliosis had worsened last summer after Tressa hit a growth spurt.
“She was standing up in the kitchen and I said, ‘Tress, why can’t you stand up straight?’ And she said, ‘I am standing up straight,’” Scott said. “I went over to her, and even though her legs were straight, her shoulders were off and her shoulder blade was protruding. It didn’t look right.”
After doing some research on the Internet, Scott made an appointment for Tressa at the Texas Back Institute for a specialist to take a look.
“The doctor who examined Tressa took X-rays and determined she had a 60 percent curvature of her lower spine and a 35 percent curvature of her upper spine,” Scott said. “She mentioned that TBI was about to bring in a scoliosis specialist, and she wanted Tressa to come back in three months to evaluate if the scoliosis had progressed.”
Three months later, they returned to TBI and met Dr. Lieberman.
“He examined Tressa, took X-rays, and it was his opinion that Tressa had additional growing to do, and this would increase her propensity for her curvature to progress further,” Scott said. Tressa was not currently in any pain, but Lieberman explained that scoliosis would probably impact her more in the future.
“If left uncorrected, over the years it could progress to the point to where it could severely limit her activities as an adult. He explained all options and side effects to us, and after much thought and deliberation, Tressa decided it would be best to go ahead and do the surgery sooner than later,” Scott said. “Dr. Lieberman told us he could probably straighten her spine to within a 15- to 20-degree curve. However, the results were even better. She is at about 10 percent today.”
Scott said Tressa’s X-rays show that her shoulders are now even and her back is nice and flush all the way across.
“I truly feel blessed to have met Dr. Lieberman and that Tressa had the benefit of having his amazing talents coupled with the SpineAssist robot to make the surgery a complete success,” Scott said. “We are now four weeks post-op, and Tressa is doing great.”
Tressa is happy about the results.
“It’s been four weeks since my surgery, and I’ve already gotten stronger and have noticed changes,” said Tressa. “I stand and sit up much straighter, and I’m no longer leaning to the side.
“Most people are uncomfortable around doctors, but he couldn’t make you feel any more comfortable and understanding about everything that’s going on,” she said. “Any questions that we had, he would answer as thoroughly as possible so that we had a full understanding. I’m very thankful to have met him and to have been in his care.”
Tressa knows how scary it can be to have spine surgery but encourages people who may need the help to pursue treatment.
“Although it’s scary at times because it’s obviously surgery, there’s a new peace of mind and confidence knowing that with the robot, the surgeons can be more precise and really know what they’re doing,” Tressa said. “For me, my biggest worry in the beginning was the recovery process. However, I’ve been getting stronger every day, and I’m confident that by the time school starts, I’ll be ready to go without any worries.”