The ExcelsiusGPS, New Technology for Spine Surgery
Dr. Steven Schopler, an orthopedic spine surgeon with Dignity Health, explains the ExcelsiusGPS, a new technology for spine surgery.
Featured Speaker:
Dr. Schopler sees patients with all types of spinal disorders, with a special interest in minimally invasive surgery for scoliosis, degenerative deformity problems, scoliosis assessment, and treatment of disc disorders and spondylolisthesis. In recent years, he has lectured and presented research on minimally invasive spinal surgery in China and Europe, as well as across the United States. Dr. Schopler enjoys teaching spine fellows and other spine specialists about new surgical techniques. He works closely with the spinal implant industry on techniques and instrumentation of the spine and holds patents on spinal implants for lateral access spine surgery. A Diplomate of the American Board of Orthopaedic Surgery, he is a member of the Scoliosis Research Society, the North American Spine Society, Pediatric Orthopaedic Society of North America, and the American Academy of Orthopaedic Surgeons. Dr. Schopler in recent years performed Kern County's first minimally invasive scoliosis surgery, first minimally invasive TLIF (Transforaminal Lumbar Interbody Fusion), first outpatient cervical disc replacement, and first multi-level cervical total disc arthroplasty (artificial disc replacement). Dr. Schopler and his wife Robin, enjoy golf, travel, and the Bakersfield lifestyle.
Steven Schopler, MD
A graduate Mechanical Engineer from the University of Wisconsin College of Engineering, Doctor Schopler received his MD from the University of Wisconsin School of Medicine, followed by Orthopedic Residency at the UCLA Department of Orthopedic Surgery, and later enjoyed a year fellowship in Pediatric Orthopedics at the Royal Children's Hospital, Melbourne, Australia. He later entered private practice in Los Angeles in 1989. For twenty years, Dr. Schopler has enjoyed seeing patients in Bakersfield, moving to live in the Bakersfield community in 2009.Dr. Schopler sees patients with all types of spinal disorders, with a special interest in minimally invasive surgery for scoliosis, degenerative deformity problems, scoliosis assessment, and treatment of disc disorders and spondylolisthesis. In recent years, he has lectured and presented research on minimally invasive spinal surgery in China and Europe, as well as across the United States. Dr. Schopler enjoys teaching spine fellows and other spine specialists about new surgical techniques. He works closely with the spinal implant industry on techniques and instrumentation of the spine and holds patents on spinal implants for lateral access spine surgery. A Diplomate of the American Board of Orthopaedic Surgery, he is a member of the Scoliosis Research Society, the North American Spine Society, Pediatric Orthopaedic Society of North America, and the American Academy of Orthopaedic Surgeons. Dr. Schopler in recent years performed Kern County's first minimally invasive scoliosis surgery, first minimally invasive TLIF (Transforaminal Lumbar Interbody Fusion), first outpatient cervical disc replacement, and first multi-level cervical total disc arthroplasty (artificial disc replacement). Dr. Schopler and his wife Robin, enjoy golf, travel, and the Bakersfield lifestyle.
Transcription:
The ExcelsiusGPS, New Technology for Spine Surgery
Bill Klaproth: (Host) Well, if you're checking this podcast out, you're probably suffering from back pain. Good news for you. There's new technology for spine surgery. It's called the Excelsius GPS. So what is it, how does it work and how can it benefit you? Well, let's find out with Dr. Steven Schopler an Orthopedic Spine Surgeon in Bakersfield. Dr. Schopler it is a pleasure to talk with you. Thank you so much for your time. So first off, can you give us a brief history of spinal surgery over the years?
Dr. Steven Schopler: (Guest) Spine surgery has been done for decades in the United States, for treatment of curvature of the spine and degenerative conditions. Back in the fifties and sixties, when spine surgery really became popular there were no implants that we put in the spine. People used to just place bone graft, adjacent to the vertebrae, and hope that the vertebrae would fuse together to keep them lined up properly. That worked poorly, but it works on occasions. Then along came the Harrington hook instrumentation, which were special hooks that engaged the vertebra. And that was an improvement over no instrumentation. It held the spine more rigid, but the problem with that instrumentation was it became dislodged if the patient would cough or sneeze or twist inappropriately. Then came the eighties and nineties when we started to develop the use of screws that engaged the vertebra and the screws is secured the fixation much better and helped line up the vertebrae much better. But the problem with the screws was it's very hard to place them in exactly the right position. It's a very small target to hit. And now we have a computer navigated instrumentation and the robotic instrumentation, which really improves our accuracy in the placement of these screws and allows us to get a more natural alignment of the spine when we're completing the surgery.
Host: That is quite an evolution of spinal surgery. And as you said, this has now led us to the Excelsius GPS, and can you explain that to us?
Dr. Schopler: The Excelsius GPS is a new robotic-assisted spine surgery system. It's made by Globus medical corporation and it's a very sophisticated device. What it does is you load into the robotic memory the preoperative images of the patient's spine. And so the robot memorizes, all of the anatomy of the patient's vertebrae. And then during the surgery, the robotic arm assists in lining up the placement of the screws and the implants that we have to deliver so accurately.
Host: So you already have a complete road map of exactly where to go before surgery.
Dr. Schopler: That's correct and it's very useful, because, the robot knows every millimeter of the patient's anatomy and it allows us to very precisely place these implants that we're using.
Host: So are there different types of spinal procedures that really benefit from the Excelsius GPS?
Dr. Schopler: Currently, we're using the GPS system for spinal fusion surgery predominantly. And in that type of surgery, we're placing screws in the vertebra to anchor them securely and then adding some bone graft along the side, or between the vertebrae. And it's mostly now used for spinal fusions. It will be useful in coming years, very soon as a matter of fact, for placement of other devices in the spine, such as for example, artificial discs and interbody implants that help stabilize the spine between the vertebrae.
Host: With these types of developments, there's often a benefit to the surgeon and the patient. So first off, what is the benefit to this surgeon slash care team?
Dr. Schopler: I think the benefits to the patient and to the surgeon are all in the same category. For one thing, the robotic assistive system allows us to place these implants with greater accuracy. There are very minimal errors associated with the placement of the implants and according to recent studies, the robotic assistive device is more accurate than even experienced spinal surgeons in placing these devices. The second advantage is speed. The robotic system allows us to place these screws with each screw taking only a few minutes to do, as opposed to about 15 or 20 minutes with some of the more labor-intensive ways of placing screws. The next thing that it helps with is matching the size of the implants for the exact anatomy of the patient. Remember that the robot memorizes, the patient's anatomy. So when we have the screws and various sizes and various lengths and various diameters, the robotic system allows us to plan the surgery with great accuracy. We know exactly the right size of screw, exactly the right diameter of the screw. We no longer have to estimate these things like we used to do prior. And then the last thing it does is it really helps us eliminate the interoperative exposure of the surgical team to the radiation that was necessary when we used to place the screws under x-rays. And that was the way we were doing it until very recently with a live x-ray machine that shoots off x-rays while we're placing the screws to make sure we put them in the right spot, and that exposed everybody in the room, including the patient, nurses, surgical techs and particularly the surgeon, it's a lot of radiation exposure and the Excelsius eliminates that completely.
Host: So a lot of benefits to both the surgeon slash care team and the patient. And then how does this affect the recovery time when using the Excelsius GPS?
Dr. Schopler: The recovery of the patients is very, facilitated by the robot because when you're placing these screws, for example, You only have to place them once, you don't have to put them in and take an extra day and go, Oh, I would like it more, a little bit to the left or a little bit to the right, maybe you have to do it again. And of course, each time you do that, it disrupts a little bit of tissue. And so the patient experiences a little more discomfort post-operatively. I think with the robotic assistive system, it really helps us get this right faster and the first time, each time.
Host: I'm sure for someone listening, they're like, I want this robot technology to be used on me. What patients are good candidates for this technology.
Dr. Schopler: Right now we're using it for spine fusion patients in the lumbar spine and occasionally in the cervical spine when they're having fusion surgeries with screws to hold the vertebrae in place. For patients having simple disc surgery or laminectomy surgery, the robot assistive device really doesn't come into play very much at this time. There will be room for that later but right now it's for spinal fusions predominantly.
Host: So it sounds like in the future, A robot such as this may be used for other procedures.
Dr. Schopler: I believe so. I think it's important to know that the way the robot works is done, the surgeon does the surgery. The robot kind of helps you line up the shot. And the way I usually tell my patients about it is if you're playing golf and you're making a long pro on the putting green. If you had a device that knew every millimeter of the putting green, the device could line up your putt and then you hit the ball and it's the same way with the robot in surgery. The robot lines up the trajectory for these screws to go in, but the surgeon actually inserts them through the sleeve that the robot is holding and that allows you to accurately place those screws. But the surgeon still has the feel of how the screws go in whether you're biting into bone properly, or if somehow there's an error and you're not hitting the target correctly.
Host: That is amazing. Dr. Schopler thank you so much for your time. Last question than anything else that you want us to know about this new robotic technology?
Dr. Schopler: I think it like all techniques has a little bit of learning curve. And so the first case is one does with it, take a few extra minutes to set all the equipment up properly. But within about two or three cases, we get the sequence down properly and it really goes right along very smoothly and it helps us shorten the time of the surgery very significantly. the most important thing it helps us do is it helps us really achieve a natural alignment of the spine with accurate placement of the implants. Something that has always been a goal of spine surgery, that we have really refined much better with this system.
Host: We are always interested in better outcomes and it sounds like the Excelsius GPS helps us with just that. Dr. Schopler this has really been informative. Thank you so much for your time. We really appreciate it.
Dr. Schopler: My pleasure.
Host: That's Dr. Steven Schopler. And for more information, please visit dignity health.org/bakersfield/ortho. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth thanks for listening.
The ExcelsiusGPS, New Technology for Spine Surgery
Bill Klaproth: (Host) Well, if you're checking this podcast out, you're probably suffering from back pain. Good news for you. There's new technology for spine surgery. It's called the Excelsius GPS. So what is it, how does it work and how can it benefit you? Well, let's find out with Dr. Steven Schopler an Orthopedic Spine Surgeon in Bakersfield. Dr. Schopler it is a pleasure to talk with you. Thank you so much for your time. So first off, can you give us a brief history of spinal surgery over the years?
Dr. Steven Schopler: (Guest) Spine surgery has been done for decades in the United States, for treatment of curvature of the spine and degenerative conditions. Back in the fifties and sixties, when spine surgery really became popular there were no implants that we put in the spine. People used to just place bone graft, adjacent to the vertebrae, and hope that the vertebrae would fuse together to keep them lined up properly. That worked poorly, but it works on occasions. Then along came the Harrington hook instrumentation, which were special hooks that engaged the vertebra. And that was an improvement over no instrumentation. It held the spine more rigid, but the problem with that instrumentation was it became dislodged if the patient would cough or sneeze or twist inappropriately. Then came the eighties and nineties when we started to develop the use of screws that engaged the vertebra and the screws is secured the fixation much better and helped line up the vertebrae much better. But the problem with the screws was it's very hard to place them in exactly the right position. It's a very small target to hit. And now we have a computer navigated instrumentation and the robotic instrumentation, which really improves our accuracy in the placement of these screws and allows us to get a more natural alignment of the spine when we're completing the surgery.
Host: That is quite an evolution of spinal surgery. And as you said, this has now led us to the Excelsius GPS, and can you explain that to us?
Dr. Schopler: The Excelsius GPS is a new robotic-assisted spine surgery system. It's made by Globus medical corporation and it's a very sophisticated device. What it does is you load into the robotic memory the preoperative images of the patient's spine. And so the robot memorizes, all of the anatomy of the patient's vertebrae. And then during the surgery, the robotic arm assists in lining up the placement of the screws and the implants that we have to deliver so accurately.
Host: So you already have a complete road map of exactly where to go before surgery.
Dr. Schopler: That's correct and it's very useful, because, the robot knows every millimeter of the patient's anatomy and it allows us to very precisely place these implants that we're using.
Host: So are there different types of spinal procedures that really benefit from the Excelsius GPS?
Dr. Schopler: Currently, we're using the GPS system for spinal fusion surgery predominantly. And in that type of surgery, we're placing screws in the vertebra to anchor them securely and then adding some bone graft along the side, or between the vertebrae. And it's mostly now used for spinal fusions. It will be useful in coming years, very soon as a matter of fact, for placement of other devices in the spine, such as for example, artificial discs and interbody implants that help stabilize the spine between the vertebrae.
Host: With these types of developments, there's often a benefit to the surgeon and the patient. So first off, what is the benefit to this surgeon slash care team?
Dr. Schopler: I think the benefits to the patient and to the surgeon are all in the same category. For one thing, the robotic assistive system allows us to place these implants with greater accuracy. There are very minimal errors associated with the placement of the implants and according to recent studies, the robotic assistive device is more accurate than even experienced spinal surgeons in placing these devices. The second advantage is speed. The robotic system allows us to place these screws with each screw taking only a few minutes to do, as opposed to about 15 or 20 minutes with some of the more labor-intensive ways of placing screws. The next thing that it helps with is matching the size of the implants for the exact anatomy of the patient. Remember that the robot memorizes, the patient's anatomy. So when we have the screws and various sizes and various lengths and various diameters, the robotic system allows us to plan the surgery with great accuracy. We know exactly the right size of screw, exactly the right diameter of the screw. We no longer have to estimate these things like we used to do prior. And then the last thing it does is it really helps us eliminate the interoperative exposure of the surgical team to the radiation that was necessary when we used to place the screws under x-rays. And that was the way we were doing it until very recently with a live x-ray machine that shoots off x-rays while we're placing the screws to make sure we put them in the right spot, and that exposed everybody in the room, including the patient, nurses, surgical techs and particularly the surgeon, it's a lot of radiation exposure and the Excelsius eliminates that completely.
Host: So a lot of benefits to both the surgeon slash care team and the patient. And then how does this affect the recovery time when using the Excelsius GPS?
Dr. Schopler: The recovery of the patients is very, facilitated by the robot because when you're placing these screws, for example, You only have to place them once, you don't have to put them in and take an extra day and go, Oh, I would like it more, a little bit to the left or a little bit to the right, maybe you have to do it again. And of course, each time you do that, it disrupts a little bit of tissue. And so the patient experiences a little more discomfort post-operatively. I think with the robotic assistive system, it really helps us get this right faster and the first time, each time.
Host: I'm sure for someone listening, they're like, I want this robot technology to be used on me. What patients are good candidates for this technology.
Dr. Schopler: Right now we're using it for spine fusion patients in the lumbar spine and occasionally in the cervical spine when they're having fusion surgeries with screws to hold the vertebrae in place. For patients having simple disc surgery or laminectomy surgery, the robot assistive device really doesn't come into play very much at this time. There will be room for that later but right now it's for spinal fusions predominantly.
Host: So it sounds like in the future, A robot such as this may be used for other procedures.
Dr. Schopler: I believe so. I think it's important to know that the way the robot works is done, the surgeon does the surgery. The robot kind of helps you line up the shot. And the way I usually tell my patients about it is if you're playing golf and you're making a long pro on the putting green. If you had a device that knew every millimeter of the putting green, the device could line up your putt and then you hit the ball and it's the same way with the robot in surgery. The robot lines up the trajectory for these screws to go in, but the surgeon actually inserts them through the sleeve that the robot is holding and that allows you to accurately place those screws. But the surgeon still has the feel of how the screws go in whether you're biting into bone properly, or if somehow there's an error and you're not hitting the target correctly.
Host: That is amazing. Dr. Schopler thank you so much for your time. Last question than anything else that you want us to know about this new robotic technology?
Dr. Schopler: I think it like all techniques has a little bit of learning curve. And so the first case is one does with it, take a few extra minutes to set all the equipment up properly. But within about two or three cases, we get the sequence down properly and it really goes right along very smoothly and it helps us shorten the time of the surgery very significantly. the most important thing it helps us do is it helps us really achieve a natural alignment of the spine with accurate placement of the implants. Something that has always been a goal of spine surgery, that we have really refined much better with this system.
Host: We are always interested in better outcomes and it sounds like the Excelsius GPS helps us with just that. Dr. Schopler this has really been informative. Thank you so much for your time. We really appreciate it.
Dr. Schopler: My pleasure.
Host: That's Dr. Steven Schopler. And for more information, please visit dignity health.org/bakersfield/ortho. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth thanks for listening.