How ExcelsiusGPS® is Helping People who Receive Life Changing Spine Surgery

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I'm Deborah Howell, and today we'll be talking about how a robotic navigation technology called ExcelsiusGPS is helping people who receive life-changing spine surgery. Our guest today is Dr. Amandeep Bhalla, an orthopedic surgeon at the Spine Center at MemorialCare Long Beach Medical Center. Welcome, Dr. Bhalla.

Amandeep Bhalla, MD: Thank you for having me.

Deborah Howell (Host): Lovely to have you with us today. Now, there's been a growing shift in the adoption of robotic surgery for surgical procedures. What exactly is ExcelsiusGPS?

Amandeep Bhalla, MD: Basically, it is a technology that we use as an adjunct to surgeries that we're doing basically that helps with navigation to make sure that we're more accurate and safer with placing implants and navigating around the spinal column.

Deborah Howell (Host): Interesting. And how does the ExcelsiusGPS work?

Amandeep Bhalla, MD: We take images of the spine and we merge that with images that we take of the patient during surgery. And the software in ExcelsiusGPS combines that information and acts as a safety check to ensure that the steps we're taking during surgery are being done at a very accurate level. Basically, it's a piece of software technology, and also has a robotic arm to it essentially that helps guide some of the steps of the procedure to ensure that the plan that the surgeon would like to do is being done to the highest level of safety and accuracy. So basically, the surgeon remains in control all the time, but the robot is using an extra layer of technology to make sure we're doing it the very best way possible.

Deborah Howell (Host): It's just fascinating. Now, spine surgery is pretty much considered the last resort treatment option for people with chronic back pain. So how does ExcelsiusGPS change that?

Amandeep Bhalla, MD: You know, the decision to have spine surgery is always challenging, and it's a joint decision that's made between, you know, the patient and the provider who they've sought care from. And never an easy step to take. And I think a lot of it is eased by education, and learning what the condition is and how surgery may help it. Oftentimes with patients, I'll take the time to show them on a model or on their MRI to demonstrate in three dimensions exactly what's going on in their spinal canal, and how a surgery may be effective in treating it. One of the things that ExcelsiusGPS does, and it affords in certain cases, is to be able to do certain aspects of procedures in a minimally invasive manner. Meaning, if I have this piece of technology that is so accurate that we can narrow the scope of the incisions, so meaning making incisions potentially smaller, which means less blood loss, less pain, easier to mobilize, that's a way that ExcelsiusGPS has changed the way I practice for certain conditions. That's why this is a positive step forward.

Deborah Howell (Host): Right. And you spoke to some of this already, but could you explain how the ExcelsiusGPS system enhances spine surgery for patients?

Amandeep Bhalla, MD: You know, the main thing when we're doing spine surgery is we want to take the pressure off the nerves often to alleviate pain or symptoms of weakness or walking and standing intolerance. And sometimes there's a component where there's instability and we have to place implants in the spinal column. ExcelsiusGPS basically changes our ability to visualize the spine, it makes it better. We can see things in three dimension even though we're only looking directly at the spine during surgery. On the screen with ExcelsiusGPS, there's a three-dimensional rendering of what's going on. So we actually have a better sense of the anatomy with this technology than without it. And it's definitely enhancing because not only do we have a better appreciation of the anatomy in three dimensions, but when it comes to actually placing implants, this robotic arm, which has software that has basically analyzed the patient's unique anatomy, is facilitating the placement of those implants. So in summary, with all that combined, it's safer and more accurate, and that's why I've incorporated it into my practice.

Deborah Howell (Host): Absolutely. Now once someone works with their surgeon and determines that spine surgery is a more permanent solution to chronic back pain, how can they know if they're a candidate for spine surgery with ExcelsiusGPS?

Amandeep Bhalla, MD: Great question. So, spine surgery is so patient-specific, really. There's so many different potential conditions and treatment options. Always we would emphasize conservative care. The vast majority of my patients are treated conservatively, things like physical therapy, potentially epidural injection, or activity modification. But there are cases where surgery is the most effective way to treat something, and that's couched in really good scientific evidence for certain conditions. And then amongst those conditions, ExcelsiusGPS may have a role in certain cases. And that is kind of both dependent on the condition but also on the patient, and the surgeon's comfort level with ExcelsiusGPS. So there's a lot of factors that go into whether or not ExcelsiusGPS is used for a patient's condition. I think if a patient is interested in it and interested in learning more about it, they should also be encouraged to ask their surgeon to understand why or why not this technology may be applicable to the type of condition they have and that they're seeking surgery for.

Deborah Howell (Host): Sure, that just makes good sense. Now, what are the potential benefits from spine surgery with ExcelsiusGPS?

Amandeep Bhalla, MD: One of the benefits definitely is that we can do things like percutaneous, which is incisions that are much smaller than traditional open spine surgery. Using this technology because we have the three-dimensional rendering of the patient's spine and are able to make sure that because it's so precise that we're not making the incision any larger than it has to be. And I think, so the benefit would be potentially smaller incisions, which usually translates into less pain and blood loss, and then of course the increased accuracy which makes the surgery safer. And that's always a chief goal whenever you're doing spine surgery, is to make it as safe as possible.

Deborah Howell (Host): Dr. Bhalla, if someone's having anxiety about spine surgery, why is ExcelsiusGPS the reason to have their surgical procedure at Long Beach Medical Center?

Amandeep Bhalla, MD: The decision to have spine surgery is something we never take lightly. And as a surgeon I always, even if I feel very comfortable doing the operation, I always empathize with that anxiety and I never take surgery lightly. I think for a patient who has made the decision to undergo spine surgery, some patients may additionally feel more comfortable knowing that there is this powerful and novel technology that helps surgeons execute their plan, particularly with instrumentation, in a safer and more accurate manner. And that can be something that inspires additional confidence in the procedure. What's incredible is that Long Beach Memorial was the first hospital in Los Angeles County to start using this technology, and particularly using it widely. And it has definitely set Long Beach Memorial apart. And I have seen patients come to Long Beach Memorial for that care because they feel that additional confidence that this is a medical center that's investing in the latest technology to help improve patient outcomes.

Deborah Howell (Host): And so as a surgeon, what would you tell someone who's afraid to undergo spine surgery and has been living with chronic back pain?

Amandeep Bhalla, MD: The first thing I would say is let's try to learn about the condition. You know, understand what's causing the pain, understand how it's limiting the patient, and how it's affecting the patient's life. What are potential treatment options? Can this be something that can be treated conservatively, or is this something that surgery would be helpful for? And if that's the case, I would really want the patient to understand why that's the case. What would be achieved and what would be accomplished in surgery that couldn't be done without surgery. And I think oftentimes that education, that finding an understanding in what's driving their discomfort and how this is affecting their quality of life, is so helpful. And then once a patient has that understanding, usually the patient's in a much better position to make informed, clear decisions for how they want to pursue treatment. And so, my biggest piece of advice really is to get a better understanding. And I think that's finding a physician that you feel comfortable with, that's able to kind of explain the underlying issue to you, and you feel comfortable asking questions from. And then from there I think making decisions is a lot easier and I think patients feel more empowered with that greater sense of understanding.

Deborah Howell (Host): You used the word empowered. Do you feel that spine surgery with ExcelsiusGPS has the power to change someone's life?

Amandeep Bhalla, MD: I do. There are conditions that are treated with spine surgery that are absolutely life-changing. You know, for example, patients who have such difficulty walking and standing and have significant pain in the legs or in the low back, and are found to have a lot of compression on the nerves and perhaps some instability in the spinal column. That's a surgery that when we treat it, when we take the pressure off the nerves and we impart stability, that can allow that patient to walk and stand and participate in activities that bring meaning to their life in a much easier way. Oftentimes they have significant if not complete resolution of their preoperative symptoms with surgery. And so it is, it absolutely can be life-changing, and the key to having successful outcomes in spine surgery is choosing the right patients to undergo the surgery and offering the surgery for the right conditions. That's really where we have an evidence-based approach and selection for patients undergoing spine surgery. Once we've come to the decision to do surgery, using a technology that allows us to execute that plan at a high level and to do so in the safest way possible and potentially in a less invasive way as well is empowering. It sets the patient up optimally for success.

Deborah Howell (Host): So Dr. Bhalla, how can people learn more about spine surgery with ExcelsiusGPS at the Spine Center at Long Beach Medical Center?

Amandeep Bhalla, MD: Sure, a great resource is to visit the website, memorialcare.org/lbspine.

Deborah Howell (Host): Well, thank you so much, Dr. Bhalla, for your time and your expertise today, we loved having you on the show. For more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time, I'm Deborah Howell, have yourself a terrific day.