Evolving the backbone of spine surgery

Barrow Magazine Spring 2018

Happening Now

Evolving the backbone of spine surgery

Dr. Juan Uribe describes the traditional approach to spinal surgery in picturesque terms. “We have to fillet people,” says the surgeon who has directed Barrow’s Spine Program since August. He’s referring to placing patients face down, making an incision down the back and folding back skin and muscle to expose the spine.

This approach guarantees a long recovery period and can result in post-operative pain worse than before surgery. Like any open surgery, there is a greater risk of complications.

“The immediate future of spinal surgery is how to decrease the footprint, and how to get to the spine through smaller portals” in the interest of reducing recovery time, medical costs and pain for the patient, Dr. Uribe says. “Can we deliver similar or better results using a different route?”

Because Dr. Uribe is at Barrow, where boundaries are always pushed, he answers the question with a definitive yes. His career has been defined by research into minimally invasive spine surgery, including a relatively new technique in which patients are placed on their side and doctors access the spine through a small incision in the side.

Neuronavigation, a computer-guided system similar to GPS, and robotic surgery also allow for minimally invasive back surgery. The latest, most advanced robotic system for performing spinal fusions was conceptualized and designed by Barrow doctors.

It uses navigation and 3D technology to help doctors pre-map their surgeries. A robotic arm precisely places implants in a patient’s spine. With smaller incisions, surgeons separate the muscles surrounding the spine rather than cutting through them, resulting in less tissue damage.

Dr. Juan Uribe performing surgery

One of the first Barrow patients to use the Globus Medical Excelsius GPS was contractor Richard Paulsen, whose back pain had him on the verge of closing his Lake Havasu business. He left the hospital with no pain and four small puncture marks in his back.

“The way I feel right now, it is amazing. It is amazing,” Richard says.

This is just the beginning, Dr. Uribe says. Spinal surgery is on the verge of great technical leaps. If engineers can make a smart phone indispensable to daily life, he says, they can reduce the footprint necessary for spinal surgery.

He describes one potential breakthrough: “In the future, the surgeon will wear a special kind of goggles. You’ll walk into the operating room. The patient is already asleep. You can see through the skin and see the spine and begin the surgery through tiny incisions.”

It sounds like something a sci-fi movie director would imagine, something way in the future. But no, Dr. Uribe says. The devices needed to make this happen exist today.

Video games use goggles and augmented reality to place a player in a virtual world. Connect that technology to a supercomputer loaded with CT images of a spine, and Dr. Uribe’s vision becomes a reality.

There are tricky software challenges to resolve, of course. Operating on a spine requires a much higher degree of sophistication than conquering a video game. But Dr. Uribe is working on building the research lab that will tackle this challenge and develop other innovative ideas.

“I truly believe that augmented reality and artificial intelligence can train computers to help us perform surgery better,” Dr. Uribe says. “The reward is safer, less traumatic surgery for the patient and getting people back to work and enjoying life more quickly. That is our goal.”

Juan Uribe, MD, is chief of the division of spinal disorders, Volker Sonntag chair of spine research, and vice chairman of neurosurgery at Barrow Neurological Institute. Dr. Uribe earned his medical degree from Instituto Superior de Ciencias de la Salud in Colombia, where he also completed a residency in neurosurgery at Hospital San Vicente de Paul. He completed a neurosurgery residency at the University of South Florida and a spine surgery fellowship at the University of Miami. Dr. Uribe is a leading specialist in the surgical treatment of scoliosis, spinal trauma, and spinal tumors, particularly with minimally invasive techniques.