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The future of spinal surgery
with spinal robotics —

the Mazor™ experience

Dr Klaus J. Schnake - With Mazor™, Medtronic offers a revolutionary robotic guidance system for spinal surgeries consisting of a table-mounted robotic arm, a base station and a corresponding AI software.

Transforming surgery with spinal robotics —
The Mazor™ experience

With Mazor™, Medtronic offers a revolutionary robotic guidance system for spinal surgeries consisting of a table-mounted robotic arm, a base station and a corresponding AI software. Features such as customizable implant selection, versatile implant trajectories and 3D-analytics not only enable surgeons to produce predictable plans and simulations ahead of surgery, but with its rigid fixation creating a closed loop between robotic arm, operating table and patient as well as its AI-supported patient registration, the system provides innovative precision in surgery.

In his lunch workshop presentation, Dr. Klaus J. Schnake of the Waldkrankenhaus in Erlangen, Germany, shared his experience with Mazor™ so far, which he started using in April 2021. From the overall performance in surgery to Mazor™ AI software in pre-operative planning, he found that the system has transformed the way he conducts spinal surgery.

Higher precision and less complications

Prior to sharing his own experiences, Dr. Schnake pointed out first studies¹ on the improvements provided with robotic guidance: They found a considerable increase in precision with significantly more superior perfect pedicle screw placement as well as less proximal facet-joint violation (- 92 %) and a reduction of overall complications such as wound infections or neurological deficits (- 69 %) compared to a free-hand technique.

The studies¹ further highlight a 5.8 times lower complication risk as well as an 11 times lower risk for revision surgery – a benefit of the high level of precision. The use of robotic guidance also caused a drastic reduction in radiation time, with Dr. Schnake highlighting a study² comparing Mazor™ in MIS robotic guided surgery to fluoroscopic guided surgery. Therefore, at similar overall surgical time, Mazor™ achieved an 80 % reduced Fluoro-time per screw.

10 to 15 surgeries to master the learning curve

However, with the technical complexity added through Mazor™, Dr. Schnake assessed that surgeons would need between 10 – 15 surgeries to master the learning curve. In his experience, it is best to conduct these initial surgeries as open surgeries, so that the system can be observed and understood. With roughly 30 minutes of calibration time per patient recorded in his clinic, he also reported that up to the first 40 surgeries, robotic-guided surgery will likely take longer than regular surgery. However, as the learning curve flattens, he found the length of surgery to even out with regular surgery. In addition, Mazor™’s calibration time has less of an impact the longer the overall surgery takes. Especially in surgeries above four screws, Dr. Schnake saw little effect of calibration time on overall surgery length.

Absolute precision in anatomically challenging scenarios

With no significant time saving, what are the key benefits for the expert? For Dr. Schnake, it is Mazor™’s pre-operative planning software and its seamless integration into the intra-operative guidance. The software not only allows surgeons to safely plan the exact screw placement ahead of surgery, but the AI-based automatic detection of the individual vertebral bodies ensures precise and successful placement even under challenging conditions. Features that he assesses as very helpful even for the most experienced surgeons – “especially in anatomically difficult situations and scenarios that would typically need a high number of intra-operative imaging to find the right trajectory.” With Mazor™, surgeons can be assured that the trajectory will be met as planned.

In addition, he pointed out that younger, less experienced colleagues also benefit from the robotic guidance, as it allows them to set more difficult pedicle screws on their own, in turn allowing the head surgeon to spend more time on other patients.

References

Fatima et al. Spine Journal, 2021
Good et al. Spine, 2021

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The data and content included in this presentation express only the clinical perspective of the presenter. They are completely independent and do not necessarily reflect the opinions of Medtronic.

The commercial name of Mazor™ is Mazor X Stealth™ Edition.

See the device manual for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions and potential adverse events. For further information, contact your local Medtronic representative and/or consult the Medtronic website at www.medtronic.eu.