Mount Sinai neurosurgeon, Dr. Jeremy Steinberger, MD talks about the same technology in a self-driving car that can better perform back surgery.
Interview conducted by Ivanhoe Broadcast News in 2022.
I want to ask you a little bit about the new technology that you’re using. What is it called, and what is it designed to do?
STEINBERGER: It’s called 7D, and it’s extremely exciting because it allows us to place instrumentation and screws into the patient with no radiation to the patient and with very precise accuracy.
How was the surgery done prior to having this technology at your fingertips? You said no radiation. How would you be able to, prior to using this, finding the exact location where you needed to place screws and rods?
STEINBERGER: Some of it is done by anatomical landmarks. You’re looking at the spine, you pick a starting point and its trajectory, and you estimate it, and you use some tactile feedback to get in the right location. Over the last few years, we’ve been drifting toward doing- using something called navigation, which is where you have a system that guides you and tells you exactly how to get it with a navigation assistance. And there are numerous studies showing that it’s more accurate to use the computer system than to do without it.
It’s 7D. Is it actually seven dimensional, or what does this 7D stand for?
STEINBERGER: I actually have to check with them exactly what they. I asked them and they explained it. There is a good explanation. I don’t remember.
Is this very much like the GPS in your car? Is there a place in space? Can you explain a little bit of how the technology works?
STEINBERGER: Absolutely. So you can basically touch a probe to the patient and you see where you are on the patient’s spine. So you can pick a starting point and then you can see a projected view of where you’re going. So like the studies now are saying it’s a 96 percent accurate to use the technology as opposed to 70, 80 percent without it. That’s not unique to 70, that’s navigation in spine surgery. But it is like a GPS in the sense that you touch the probe to the patient, and you have the ideal trajectory, and a lot of confidence knowing you’re putting it in the perfect location.
When you have that confidence, and when you know that you’re at the right angles, what does that do for the surgeries? Is it faster? Is it easier to recover for the patient? What are the benefits?
STEINBERGER: I think it’s faster. It’s less stressful, and in a way it’s more educational. We’re teaching residents. And they can use this software where they can line it up pretending they don’t have the technology. They can pretend it’s not there, lineup the screw that they’re going to place, and then as they’re about to, look and say, hey, is this good or is this often some dimension? And if it is, it’s like a safe way to learn because without it, that screw it could have ended up in the wrong location.
Now, when you have a screw that’s in the wrong location, what does that usually require that for the patient?
STEINBERGER: It depends. There’s certain danger zones where if the screw is too angled in toward the nerves, you can injure a nerve, or also if it’s too low, it can injure the nerve. You can also have a less harmful breach in the instrumentation where you can be lateral or superior, and that’s less close to the dangerous structures, but then you still will not have as good of a fixation point as you would if the screw were perfect. At the end of the day, we want all of our screws to be perfect.
The light which you moat to the casual observer would look like it’s just a fixture to allow you guys to have more light to see what’s going on. But that’s not the case. Does that actually serves a specific purpose?
STEINBERGER: Yes. So, the flash of light that you see lasts about two seconds. In that flash of light, you’re taking thousands of fiducial points in space. And that is ultimately like that two-second flash is what links it up to the pre-operative imaging, that’s what links the patient to the technology, and that’s when you can check to confirm that you’re accurate. A very important step. You want to make sure it works. You never want to blindly trust it. But then once you do, you’re good to go. So it takes two seconds, and then you’re good to go, as opposed to any other system that I’ve used.
Are you driving that or is there a technician that is driving the two seconds flash?
STEINBERGER: There’s a foot pedal that we can use.
So, you’re hitting the foot pedal to get the flash. Now, do you do that before every screw you place, before every different move you make, or how often do you have to do that?
STEINBERGER: If you’re doing, let’s say, four screws on each side, you can do it in two flashes of light. So we can get about two levels with one flash.
How new is this? When did you guys start using this?
STEINBERGER: I saw a YouTube video about it, maybe three years ago. I was very excited about it. It seemed very new and innovative, and I reached out to the company on their website. I got a call back the next day. We were trialing it a few weeks later. During the trial, not just me, but a lot of the other surgeons got really excited about it, and then we started to push Mount Sinai to acquire it and bring it in.
How many do you have?
STEINBERGER: There’s three. There’s two at this hospital, and one on the West side.
Do you anticipate this to be the standard way that surgery is done?
STEINBERGER: I think it’s a very rapidly evolving space, and I think it will be eventually the standard of care to never have a screw end up where it’s not perfect or certainly where it’s not causing harm to a nerve. Whether it’s this technology or something else that’s coming out, that’s hard to say. But it’s definitely a big step in the right direction.
Can you talk to me a little bit about Sam?
STEINBERGER: Sam is a patient who had a complex issue to start. He had scoliosis and multi-level, basically numerous nerves that we’re getting compressed in numerous places. He had a component of central stenosis, meaning the sack of nerves is severely compressed and compromised like a water balloon compressed into a corner, but also he had nerves that were compressed as the nerve leaves the spine to go down to the leg. So we ended up doing a complex scoliotic repair and fixation. And we use this technology. And I think in that specific case, it cut down time. It made it really streamlined and fast, and it was a really dramatic pre to post X-ray, but also more importantly, a dramatic pre to post how he felt. He was debilitated by pain, and then the day after surgery he was walking briskly and without pain that he had beforehand. And I have to give some of the credit to him, because he’s a tough guy. Most people don’t just get up and walk right after a big surgery like that, but he bounced back very quick.
Is there anything that I didn’t ask you that you would want make sure people know about this technology?
STEINBERGER: I think one of the big keys is, right now, if you want to use navigation to put instrumentation into a patient, it’s a very time consuming process. You either have to bring in a large intraoperative CRM that turns into a doughnut over the patient, does like an intraoperative CAT scan. This is the first one where the navigation is caught up to the speed of the surgeon. So it doesn’t slow us down at all. If anything, I feel like it speeds me up.
How far away are we from 8D?
STEINBERGER: Couple weeks. There’s an Israeli company working on it.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Elizabeth Dowling
(347) 541-0212
Elizabeth.dowling@mountsinai.org
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