New 3D Imaging Device Enhances Spinal Surgery at Middlesex Health

Spine surgeons at Middlesex Health are now using a revolutionary new technology that helps them visualize the spine in three dimensions, ensuring greater accuracy and safety for patients during surgery. The Excelsius3D intraoperative imaging device allows the surgeon to image the spine and helps guide them while placing instrumentation into the spine, working in conjunction with a robotic navigation system. Middlesex Health is the first health system in New England to offer this technology.

In the past, surgeons relied on an intraoperative two-dimensional fluoroscopy device called a C-arm. By comparison, Excelsius3D produces images in all three dimensions and also functions as an interoperative CAT scan. It is used in a variety of spinal surgeries, treating herniated discs, spinal stenosis, scoliosis, repairing fractures, stabilizing unstable spines due to cancer and spinal fusions. It’s also used for complex surgeries of the cervical spine, or neck.

The technology combines three types of imaging—cone-beam CT scan, fluoroscopy and digital radiography—into one piece of equipment, minimizing the amount of equipment needed in the operating room.

Excelsius3D works alongside ExcelsiusGPS, a spine robot that Middlesex Health began using in 2018 to view patient anatomy during minimally invasive spine surgeries.

While spine surgery was already safe and effective before Middlesex Health acquired Excelsius3D, the new technology offers an even further measure of precision, doctors expressed. The Excelsius3D allows for real-time viewing of the patient’s anatomy and more precise placement of implants, such as cages and pedicle screws, during surgery. The technology also decreases surgical time.

On the day of surgery, patients have images taken of their spine. These images are then loaded into the Excelsius3D. The images are used by the surgeon to create an operative plan based on the patient’s anatomy. The images are then used to help the surgeon decide the optimal size and placement of the implants. The surgeon visualizes the screw and cage location on a high-definition display, allowing for real-time feedback for maximal accuracy. The screws are then placed using instruments. Excelsius3D further improves the precision and speed of Middlesex’s spine robot: ExcelsiusGPS.

“It’s another tool to add to the safety and accuracy of the surgery,” stated Joseph Sohn, a Middlesex Health spine surgeon. “Middlesex is staying current on the latest technology. As we get more experienced, the placement of the screws becomes much faster, and that’s better for the patient, surgeon and staff.”

Patients do not take spine surgery lightly, Sohn said. Often times, they are suffering from severe low back and leg pain in addition to tingling, numbness and weakness in their legs. They have difficulty carrying out the normal activities of daily life like standing, walking and sleeping.

“Many of our patients have what’s called spinal stenosis, which is the pinching of the nerves in the spine,” Sohn added. “And a lot of them have some instability; that’s the reason why we perform the fusions.”

Dr. Jeffrey Bash, another Middlesex Health spine surgeon, added that the health system’s new Excelsius3D technology improves placement of the spine instrumentation used in spinal fusions while reducing operative times and enhancing safety. It allows spine surgeons more surgical options.

“It’s a remarkable system,” Bash explained. “It cannot even be compared to older intra-operative technology. The Excelsius3D device expands our minimally invasive capabilities. The system significantly improves the surgeon’s ability to safely navigate the delicate spine.”

Drs. Sohn and Bash are excited to be using this new technology, saying that it will allow them to perform more spinal surgeries using a minimally invasive approach.

Both Drs. Sohn and Bash have many years of experience with minimally invasive spine surgery. Dr. Sohn has been in practice for 17 years and Dr. Bash for 22 years. Patients come from all over New England to seek treatment. Dr. Bash also participated in the first artificial disc replacement surgery in the U.S. in 1999. Both surgeons helped to develop spinal surgery implants and techniques, and they also teach other spine surgeons about new technology and procedures.

The doctors learned about Excelsius3D at a medical conference and advocated for it for several years.

“The community is very fortunate that Middlesex Health understands the importance of this kind of technology and was willing to spend the resources on a piece of technology that allows us to further improve patient safety and outcomes,” Bash commented. “And the image quality is amazing. It’s substantially better than the preexisting technologies that are out there.”