Dr. Villavicencio on ‘revolutionary’ robot-assisted spine surgery

Millions of Americans live with chronic back pain. From shooting pain while walking or bending over to bursts of pain when sneezing, the discomfort isn't always limited to the back. The pain can also travel down the legs.

“Chronic back pain can often be controlled with non-surgical treatment options. But if conservative options don’t provide symptom relief, minimally invasive Mazor X robotic-guided spine surgery can help,” said board-certified neurosurgeon Alan Villavicencio, MD, during a free online health lecture.

Video: Watch "Relieving back pain with robot-assisted spine surgery"

Types of back pain

According to Dr. Villavicencio, there are three major types of back pain:

• Acute – Sudden, intense pain that typically resolves within a few days or weeks
• Subacute – Pain lasting between 4 and 12 weeks
• Chronic – Deep, dull or aching pain that usually lasts over 3 months

“About 30% of back pain is acute, and 60% is chronic. Then about 10% or so is in between, or subacute,” he said.

What causes chronic back pain?

“Most chronic back pain involves a pinched nerve or irritated nerves, causing muscles to tense up and trigger pain. Chronic back pain can also be caused by inflamed joints, called the facet joints, which are in the back of the spine,” Dr. Villavicencio explained.

Dr. Villavicencio discussed the most common conditions that bring about a pinched nerve or inflamed joints, including:

• Degenerative conditions – These occur naturally with age and are the most common culprits for chronic back pain.
• Deformity – This includes conditions such as scoliosis and other issues associated with exaggerated curvatures in the spine.
• Trauma – Fractures of the spine and other injuries that may injure the spine come under this category.
• Infection – Back pain resulting from spontaneous infections secondary to things such as intravenous drug use, skin or urinary tract infections.
• Tumor – Cancer can affect the spine either primarily or secondarily from a metastasis.
• Inflammation – Ankylosing spondylitis and other inflammatory conditions make up a small subset of individuals experiencing back pain.
• Osteoporosis – This condition weakens bones.

Most common degenerative spinal conditions

Degenerative spinal conditions are the most common reasons for chronic back pain. Some degenerative spinal conditions include:

• Disc herniation (bulging disc) – Disc herniation occurs when a disc—one of the rubbery cushions that sits between the vertebrae and stack to make your spine—tears and part of the disc’s internal material extrudes through the tear. It can occur in any part of the spine and irritate a nearby nerve. “Disc herniations can be caused from just aging where the disc degenerates. An injury can also cause a herniated disc. Prolonged compression can lead to permanent nerve damage,” warned Dr. Villavicencio.
• Degenerative disc disease - This is an age-related, wear-and-tear condition. The cushiony discs between the vertebrae of the spinal column normally allow for flexing and extending of the spine, acting like shock absorbers. “Over time, the discs between the vertebrae start to deteriorate and break down. This causes anatomic changes that then result in nerve irritation or put abnormal pressure on the spinal joints,” Dr. Villavicencio explained. Almost all adults have some varying degree of degenerative disc disease, which begins to develop during teenage years when the discs start to lose their hydration and fluid.
• Spinal stenosis - In spinal stenosis, the spaces in the spinal canal start to narrow. “All of us, as we get older, will develop some degree of spinal stenosis. For most people, stenosis results from degeneration and arthritis,” said Dr. Villavicencio. “When the spinal canal narrows, the open spaces between the vertebrae start to get smaller and can pinch the spinal cord or the nerves around it, causing pain, tingling or numbness in your legs, arms or torso. The pain especially occurs when a person is standing up straight or erect and gets symptom relief when leaning forward.”
• Spondylolisthesis – This wide-spread problem in adults occurs when one vertebra is in misalignment from another vertebra. “There’s a true ‘slip’ of one bone over another one,” stated Dr. Villavicencio.

Surgical treatment

Approximately 80% of patients will experience pain relief from non-surgical treatments. For the 20% of individuals who don’t respond to non-operative solutions or have neurologic issues, surgery may be necessary.

Technology has advanced rapidly in recent years with minimally invasive surgery becoming more common. This type of surgery typically involves:

• smaller incisions
• less scarring
• less blood loss
• shorter hospital stays
• less post-operative pain
• faster return to normal activities

Mazor X™ robotic-guided spine surgery

Boulder-area residents suffering from painful back conditions have local access to an advanced surgical system that can make minimally invasive spine surgery safer and less painful.

“The Mazor X robotic-guided spine surgery allows us to perform minimally invasive surgery with more accuracy and consistency. It basically facilitates minimally invasive spine surgery,” Dr. Villavicencio explained. “We can make even smaller incisions, which result in smaller scars, shorter hospitalizations, lower risks of side effects, faster overall recovery, less pain and less blood loss.”

Mazor X combines proprietary software to plan the surgical procedure, a robotic arm to precisely guide the placement of implants during complicated spine surgery, and real-time imaging feedback to ensure the procedure proceeds as planned. These deliver a higher degree of accuracy throughout the surgical procedure, providing better outcomes for patients compared to traditional spine surgery.

“With Mazor X, we can create an individualized 3D surgical plan pre-operatively. Then using its precise stereotactic navigation during the procedure, the Mazor X™ automated robotic arm holds key surgical instrumentation in place. Robotic guidance helps your surgeon execute the custom surgical plan with exceptional precision through micro incisions,” said Dr. Villavicencio.

The Mazor X is used for surgeries where the surgeon needs to implant an immobilization device in a patient’s spine, particularly one that involves putting screws into the bones of the spine.

Dr. Villavicencio pointed out that “it helps eliminate error and surgical time associated with free-handed screw and implant placement. In fact, it improves the accuracy of screw placement by up to 100%.”

Why robotic spine surgery?

• Smaller scars
• Shorter hospitalization time
• Lower risk of adverse side effects
• Faster overall recovery
• Less pain
• Less blood loss
• Quicker return to normal activity

Conditions that benefit from robotic surgery

• Degenerative disc disease
• Herniated disc
• Spinal stenosis
• Scoliosis and kyphosis
• Spondylolisthesis

If you’d like to learn more about the treatment options for your back pain, or to find out if you’re a candidate for minimally invasive surgery with the Mazor X robotic-guidance system, schedule an appointment with Alan Villavicencio, MD, by calling (303) 938-5700.

Click here to view/download a PDF of slides shown during Dr. Villavicencio’s lecture on “Relieving back pain with robot-assisted spine surgery.”

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