Kornelis Poelstra, MD, PhD, recently implanted what was reported to be the first Molybdenum-Rhenium rod in a patient during a spinal fusion on the West Coast.
Dr. Poelstra, of The Robotic Spine Institute of Silicon Valley in Los Gatos, Calif., used the Mazor X robot to plan the operation and position the hardware.
Here, he breaks down the procedure with the MoRe alloy and discusses how robotics will develop in the long-term as the industry looks for more cost-effective solutions to spine surgery.
Note: Responses are lightly edited for style and clarity.
Question: How do you see the MoRe alloy developing in spine? Will the new range of smaller implants enable more cost-effective options for spine surgery?
Dr. Kornelis Poelstra: The MoRe alloy is comprised of unique material properties and is 2-3 times stronger than currently used titanium- or cobalt-chromium alloys. It has four times greater durability and almost no recoil when bending the material. Because of its strength, it is capable of creating two-rod constructs with greater durability than prior four-rod constructs made of cobalt chromium or titanium, which decreases the cost of the entire construct.
The material is pure so there are no trace elements of nickel or other contaminants required to keep it stable, which reduces the risk for harmful ion release, decreases metal wear as well as potential adverse and allergic reactions by the patient. Imagine the possibilities for ortho-trauma, upper extremity, foot and ankle and joint replacement surgeries.
The entire construct can be created with 50 percent less metal by volume, which decreases the bioburden for the patient, hopefully diminishing the likelihood for postoperative unexplained back pain and pseudoarthrosis formation.
Q: Can you break down the preoperative planning and intraoperative procedures with the Mazor X robot? Is there anything you did differently using the MoRe alloy?
KP: With the Mazor X robot, the actual technology platform is more important than the robotic arm. Utilizing highly advanced planning capabilities for hardware placement and deformity correction, we can now dial in our correction with much greater comfort prior to surgery, and then execute it flawlessly following our own, well-defined plan in 3D space, which reduces stress on the team during surgery and the cognitive burden to the surgeon.
Where we are traditionally quite stressed performing osteotomies and complex deformity corrections, having a carefully planned procedure to follow makes surgery much less time-consuming and makes it much better to execute the individual tasks required for a successful operation.
Based on the small size of the MoRe hardware, screw placement can be more refined preoperatively, with greater soft tissue sparing approaches to the spine through smaller incisions and less soft tissue disruption to get the construct created. Altogether, this has led to fewer complications and readmissions, and reduced the length of hospital stays for patients.
Q: What does the future look like for robotics in spine? What further applications could be on the horizon for robotic spine surgery?
KP: The future for robotics is bright. In addition to trajectory guidance to place hardware and perform complex preoperative planning procedures, robots are soon going to be able to have greater autonomy in the OR, I hope. We must discuss these advances together with regulatory bodies such as the FDA, but this autonomy will not be far off.
Robotic systems should be able to nearly autonomously place hardware, further reducing outliers and human error, help us with discectomy procedures and end plate preparation in a more predictable form as well as with decompression surgery or the spinal canal. Utilizing advanced learning, I am confident that we can start manipulating muscle and fascia and have robotic assistance soon that will help us open and close surgical approaches.
People should also not forget the highly advanced predictive analytics that help us with the decision-making processes of which surgical technique to offer to which patient. Robotic and computer systems are much more capable of analyzing large amounts of variables to help us reduce complications and make better choices for our patient population.
Q: How will robotics fit in as the industry looks for more value-based care and cost-effective options in spine surgery?
KP: Cost effectiveness does not come out of one individual encounter or a single procedure for one patient. I think greater cost effectiveness will come about as we treat large groups of patients more appropriately with better technology and reduce their 90-day readmission and complication rates, get them back sooner to gainful employment and allow them to become independent and take care of their families.
In the intermediate to long-term follow-up, better index surgery should reduce adjacent segment degeneration, pseudoarthroses or failed fusions and hardware failure, which can potentially lead to a reduction in post-laminectomy type back pain, reduced narcotic use and the provision of a greater quality of life for the population as a whole.