Combining Two New Surgery Techniques to Improve Spine Outcomes

The ideal patients for minimally invasive lateral access and robotic spine surgery are those with a focused problem in one, two or three spinal levels.

Published in Framework - Framework Summer 2020 and Orthopaedic Surgery - Orthopaedic Surgery Spring 2020

Amit Jain is on the forefront of spine surgery innovation as an early adopter of minimally invasive lateral access and robotic spine surgery, or MILARS. “This specific combination of technologies — lateral access and robotics — has the potential to change our field, to move the entire field of spine surgery forward,” says Jain, chief of minimally invasive spine surgery and assistant professor of orthopaedics and neurosurgery at Johns Hopkins. “This innovative technique can really provide significant benefits to our patients.” Jain is part of a team of Johns Hopkins surgeons, including Jay Khanna, Khaled Kebaish, and Nick Theodore, who are developing clinical and research protocols for this combination of procedures.

As opposed to traditional open spine surgery, which involves extensive muscle manipulation, MILARS uses a different approach. “Lateral access allows us to perform spine surgery in a way that is frequently muscle sparing, which has profound implications for recovery. You can substantially minimize blood loss and the duration of hospital stays because it is not as disruptive of the physiology of the body,” Jain says.

Lateral access spine surgery allows for indirect spinal decompression, which avoids the nerve irritation that may occur with direct manipulation. These aspects combined make the procedure more efficient in terms of operating room use. “You can accomplish a goal very quickly. For example, you can perform a lateral access surgery with robotic screw placement in less than an hour, as opposed to an open approach that could take several hours,” Jain says.

MILARS relies on a state-of-the-art robotics navigation and guidance system, which was approved by the FDA in 2017. Surgeons can use the robot to guide pedicle screw placement. “It’s precision medicine,” Jain says. “With robotics you can, in a very accurate manner, instrument the spine, making the operation safer for the patient.”

The ideal patients for this combination of techniques are those with a focused problem in one, two or three spinal levels. Patients with spondylolisthesis, foraminal stenosis or lumbar spinal stenosis can benefit greatly from MILARS. Other indications include adjacent segment disease and degenerative scoliosis.

Jain also sees the potential for major savings in health care resources. “More than a quarter million lumbar fusions are performed in the country each year, and if perhaps a fifth of them can be performed with MILARS, the reductions in blood loss, morbidity, intensive care unit stays, and hospital stays would have a substantial impact,” Jain says.

Patients will appreciate the benefits, as well, he says. “Patients love having faster recovery, better outcomes, smaller scars and the ability to go home the next day instead of a week later.” For many patients, the difference in recovery time would make traveling to Johns Hopkins, even from far away, worthwhile. “We are among a handful of surgeons nationally that combine lateral access surgery with robotic spine operations. At Hopkins, we could provide a fundamentally different surgical experience with MILARS than that of the traditional method available at local community hospitals,” he says.

Jain has published over 130 peer-reviewed journal articles focused on improving outcomes of spine care.

Innovating Treatment for Recurrent Patellar Instability

Johns Hopkins is one of a few centers globally to use four-dimensional computed tomography with MRI to model patients’ joints and better predict postoperative outcomes.

A static image captured from a dynamic 4DCT scan demonstrates unilateral patella maltracking in a 19-year old patient who has a history of recurrent patella dislocations.

Innovations for Children with Steroid-Induced Osteoporosis

A pediatric endocrinologist and researcher in the Department of Orthopaedic Surgery, Janet Crane is uniquely positioned to understand the needs of her patients.

Spongy bone tissue affected by osteoporosis

New Protocol Reduces Opioid Use by Up to Two-Thirds in Trauma Patients

The pain alleviation protocol involves two pathways, one for opioid-naïve patients and another for opioid-tolerant patients.

Portrait of Babar Shafiq