Lending A Hand

Use of robotic arm enables pinpoint accuracy during spine surgery

Severe, ongoing back pain can be debilitating. Some conditions can affect one’s ability to walk or carry out basic activities. Amanda Murdolo started experiencing that kind of pain a few years ago and, by the time she saw a doctor at Hospital for Special Surgery (HSS), she could barely walk for 10 minutes without having to stop.

“I couldn’t do much physical activity,” recalled Murdolo, now 24 years old. “Simple tasks like standing and doing dishes became painful. At times it felt like someone was pulling both ends of the nerve in my left leg really tight.”

After seeing several doctors, Murdolo, a graduate student who lives on Long Island, was referred to Darren Lebl, MD, a spine surgeon at HSS who practices in both Manhattan and at HSS Long Island in Uniondale. Around the time she saw Lebl, he had just completed his 100th minimally invasive, robotic-assisted spine surgery.

The robotic system would be used in Murdolo’s surgery to correct a spinal condition called spondylolisthesis, which causes one of the lower vertebrae of the spine to slip forward onto the bone directly beneath it. This was putting pressure on a nerve.

Since the pandemic was a concern in 2020, Murdolo had her first consultation with Lebl remotely. After she felt comfortable talking to him, she went to his office for an examination, an explanation of her condition and what surgery would entail. He explained that he performed the procedure with assistance from a robotic arm, which allowed for an ultraprecise surgery.

“Over the past few years, advances in surgical technique and technology have enhanced the accuracy and predictability of spinal surgeries, and patients like Amanda benefit,” said Lebl. “Advances such as computer navigation, 3D imaging and robotic-assisted surgery have been tremendous in terms of allowing us to do less invasive, yet more precise surgeries.”

The use of very small incisions preserves muscles and other structures surrounding the spine, so patients generally experience less pain after surgery, a shorter hospital stay and a quicker return to activities compared to traditional open surgery, he explained.

Murdolo had a spinal fusion in December 2020.

“A ver tabra in her lower spine had shifted or ‘slipped’ forward, causing impinge ment on a nerve root,” Lebl explained. “Through a minimally invasive technique, we were able to realign her spine and take the pressure off the nerve to relieve her pain.”

Lebl uses the robotic system to treat the condition that Murdolo had, as well as a herniated disc, spinal stenosis or scoliosis. Prior to surgery, detailed images of the patient’s anatomy are obtained to plan and customize the proce dure. Preoperative CT and Dr. Lebl with the robotic system

MRI scans create a three-dimensional map of the patient’s spine that is used during surgery. Lebl performs the procedure with small incisions and robotic guidance, always maintaining full control. Visualization of the surgical field is provided by a computer console that displays the high-definition 3D image of the patient’s anatomy in real time.

Many spine surgeries, including Murdolo’s, require the use of hardware such as titanium screws to stabilize the spine, and their accurate placement is critical to the success of the surgery.

“The robotic arm, along with 3D imaging and navigation technology similar to GPS, allow for pinpoint accuracy in the placement of hardware, and this is a major advantage of the system,” Lebl said.

Murdolo said the thought of having spine surgery was a frightening prospect. It would be the first surgery she ever had, and she was worried about pain. But it was never an issue.

“I was very surprised at how little pain I had after surgery,” Murdolo said, who had the procedure on a Friday and went home on Monday. She has been painfree since the surgery and looks forward to receiving her Doctor of Audiology degree in 2024.

Lebl notes that the use of robotics in minimally invasive spine surgery requires special training and advises patients to choose a physician with ample experience in the technique. He also recommends that patients choose a surgeon with whom they feel comfortable and who takes the time to answer all their questions. When considering where to have surgery, hospitals that perform a high-volume of such procedures have been shown to have the best outcomes.

—Hospital for Special Surgery (HSS)