By Laura Freeman
Alabama Bone And Joint Clinic neurosurgeon Winston Capel MD is pleased with the results he’s seeing with robotic S.I. joint surgery
“The S.I. joint is involved in about 75 percent of the back pain cases we see,” Capel said. “When the problem progresses to the point where conservative measures no longer bring relief, it may be time to consider surgery. The difficult part of this decision is that the chances for easing the pain and giving your patients a meaningful improvement in quality of life depends in large part on getting exactly the right placement for the implant. The anatomy can be complicated and it’s different in each patient.
“With traditional methods, you have to rely on x-rays and your own skills and experience, and hope the patient gets the good outcome you want. The implants cost around $3,000 each, so it’s something you need to get right the first time.”
Capel has found that getting it right the first time is simpler when he can do much of the more difficult work in advance using calculations from data input directly from the actual patient’s own imaging to preplan and guide the surgery.
“We explained to Brookwood Medical Center that the precision we get with robotics is becoming the standard of care for spinal surgery,” he said. “We’ve been impressed with the results we see using the Mazer surgical robot at Brookwood. It differs from the DaVinci robot in that it’s more about advance planning to work out each move ahead of time, and then it guides you step by step through the procedure. You’re still there making the incisions and using the drill. It’s more work upfront with planning and programming, but you can double-check the details in advance, and it simplifies what you need to do on the day of the procedure.”
The response from patients has been very positive when learning that robot-assisted surgery is being used to enhance the odds for success.
“It seems to give them more confidence that they are making the right decision to go ahead with the procedure. It also gives surgeons greater confidence that they will be able to make real improvements in their patient’s quality of life,” Capel said.
The criteria for deciding whether a patient is a candidate for this surgery includes confirmation testing and observation following the course of the condition.
“We try them with a lumbar injection that combines Marcaine and cortisone,” Capel said. “If the pain is relieved the first day by Marcain and by cortisone the next, that’s a positive indication that we have correctly identified the S.I. joint as the source of the problem.
“If the patient has failed to get relief from physical therapy and other conservative measures for over six months, surgery is likely the most promising next step to bring relief.”
Robotic S.I. surgery is usually done as an outpatient procedure with the patient ready for discharge by evening to recover at home.
“They go home with crutches and/or a walker, and we follow their progress over the next four weeks. After five weeks, if they remain pain free, they can begin to return to the normal activities of everyday life,” Capel said.
Back pain is one of the most common complaints that bring patients to a doctor’s office, and it is also a frequent reason for lost work days and long-term disability claims. Because of the human ability to walk upright, putting the demands of gravity and the weight of carried objects on the lower back, the S.I. joint too often takes the brunt of pain and injury. However, work life in our modern world also puts plenty of stresses on the neck and thoracic areas of the spine.
Having used the robot in a number of cases, Capel says its capabilities would also likely be well suited to other types of back surgery, though for the present, he is focusing primarily on using it for S.I. joint surgeries. About 95 percent of his work as a neurosurgeon involves surgery of the spine, but he also does cranial procedures when it’s his turn to cover on call emergencies.
There are so many people living with back pain, and as of now, not many surgeons in this region are trained and adept at using the Mazer robot to ease their suffering. Winston Capel, MD is one of them.