There is no doubt the spine is one of the most important structures in the human body, playing a vital role in supporting and protecting the nervous system. Its importance is reflected in the fact that when the spine is damaged or affected by disease the results can be devastating. The good news, however, is that spinal surgery is going through seismic changes in the UK and it is in large part due to Mr Sean Molloy, a senior spinal orthopaedic surgeon who works at both the Royal National Orthopaedic Hospital (RNOH) and St John and St Elizabeth Hospital.
In short, Mr Molloy’s implementation of both spinal navigation and robotics has led to highly accurate and minimally invasive operations of the spine that are paving the way for a new era of much safer and effective treatment.
Mr Molloy, who brought the first spinal navigation system into the country nine years ago, explains why it is so important. He says, “It’s very much like a sat nav. It is a pre-ordained map of the spine based on either a scan beforehand or a scan intra-operatively that then guides all the instruments I use, ensuring they avoid any important structures and to be able to fix the spine or operate on the spine in a way that will avoid complications.”
This technique reduces blood loss and allows the surgeon to operate around corners without having to physically see around them. In comparison to traditional methods, the risk of damaging the spinal cord is greatly reduced.
Mr Molloy says, “Just as a sat nav can tell you where to avoid traffic, our system effectively gives you warning signs of where you can and can’t go with green and red markers, ensuring you stay within a safe zone.”
One example of where this can be incredibly useful is in dealing with tumours that are close to the spine.
Mr Molloy says, “The best way to get a complete tumour cure is to circumnavigate around it and leave a margin. In the past, we could not see around the corner, which meant there was the risk of cutting into it and causing tumour spill or damaging the spine. Now we can safely cut around the tumour and completely remove it.”
In addition to the spinal navigation system, Mr Molloy has also been using robotics, in this case, the Mazor X Stealth surgical robot, that works with the navigation system to increase accuracy when operating on or around the spine.
Working in conjunction with the spinal navigation system, robotics allows for precision engineering that was previously not possible.
Three months ago, Mr Molloy operated on a 14-year-old girl called Emma who had severe scoliosis (curvature of the spine). It was the first operation of its kind in the UK and has consequently been a huge success (as reported in The Mail).
Mr Molloy fixed Emma’s spine in place by screwing two titanium rods either side of it. While Mr Molloy manually adjusted the screws, the robotics precisely defined where they needed to be.
He says, “The robot locks you into a target that you can’t then deviate from, so you’re physically putting the screw in yourself but the robot is controlling exactly where it goes. As a result, the risk of the screws breaching and causing neurological injury are significantly lessened.”
By looking at an X-ray of Emma’s spine, you can instantly see how precisely they have been positioned.
To the left is Emma’s spine after the operation (n.b. the strips running down each side of the spine in the lower back are from a brace the patient is wearing).