Five Questions With: Dr. Alan Daniels

This spring, Dr. Alan Daniels, chief of spine surgery at University Orthopedics Inc., along with a team of spine surgeons at The Miriam Hospital, used a robotic assistant to perform a minimally invasive spine procedure. The surgery was the first in Rhode Island to be performed with the Mazor X Stealth Edition Platform, a system that allows surgeons to create a 3D plan for procedures before entering the operating room. During surgery, the system’s robotic arm holds instruments in place while surgeons make tiny incisions with the help of robotic technology. 

Daniels discusses the Mazor X and what the use of it could mean for spine patients in need of surgery in the Ocean State. 

PBN: How does traditional spine surgery differ from procedures that use the Mazor X system? 

DANIELS: Traditional spine surgery is highly successful in providing patients relief from a wide variety of spinal conditions. The goals of surgery are generally to take pressure off of compressed nerves, stabilize the spine (when needed) and correct deformity. The Mazor X system allows us to achieve these goals in less-invasive ways using smaller incisions and less X-ray radiation for the surgical team and the patient. Patients with smaller incisions and minimally invasive approaches often have a faster recovery with less scar tissue, ideally leading to better outcomes. The robot also allows for amazing accuracy of screw placement, reducing the chance of any mal-positioned spinal instrumentation.

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PBN: How often do you expect to use the Mazor X in the operating room now that you’ve used it successfully during a procedure?

DANIELS: The Mazor X can be used in a wide variety of procedures, generally in the thoracic and lumbar spine. We will be using this technology on a daily basis at The Miriam Hospital at our busy spine center, where we performed more than 700 spinal operations last year alone.

PBN: What types of patients and procedures is the system a good fit for? 

DANIELS: At University Orthopedics Inc. and The Miriam Hospital, we care for patients from birth to very advanced age with spinal conditions. We have a comprehensive team that is able to care for all spinal conditions right here in Rhode Island. Nothing is too complex for our highly experienced team.

The Mazor X system is currently most useful for degenerative (arthritic) lumbar spinal conditions, but this technology is rapidly expanding and can also be used on patients with spinal tumors, infections, trauma and then also in the future will also be used for cervical conditions.

PBN: What kind of training did you have to complete in order to use the Mazor X? 

DANIELS: Prior to ever performing a robotic spine surgery (or a minimally invasive spine surgery), spine surgeons go through rigorous training to be able to complete these challenging, high-risk operations. Robotic spine surgery helps us to place instrumentation (screws) into the spine in a safe manner, but this can only be done after the surgeon is well adept at placing screws without a robot. Following completion of full residency and fellowship training, additional robotic training – both in the classroom and in the laboratory utilizing cadaver spines – was completed by all of our robotic surgeons at The Miriam Hospital.

PBN: Could a system such as the Mazor X make it possible to perform surgery for conditions that were previously considered inoperable? 

DANIELS: The Mazor X is a wonderful tool in our armamentarium to treat a wide variety of spinal conditions. However, it currently does not allow us to treat conditions we never treated before.

One reason is that there’s been such a massive explosion of technology over the last two decades that already enables us to care for a huge variety of patient issues. Rather than allowing us to treat previously inoperable conditions, it allows us to do the same surgeries in a safer, more effective way with a faster recovery for the patient.

Robotic spine surgery provides us with yet another tool to optimize the care of our patients. Our goal at University Orthopedics is to provide the best outcome for each patient, with or without surgery, and to get them back to the activities that they like to do. Although many people believe spine surgeries are inherently dangerous and often have bad outcomes, that is not the case when there is a well-experienced, skillful and careful surgeon performing the operation with the appropriate technological assistance.

Elizabeth Graham is a PBN contributing writer.