Mark Giovanini, MD, is a neurosurgeon with NeuroMicroSpine, a Pensacola, Fla.-based spine practice focused on minimally invasive spinal procedures.
The practice has developed a comprehensive sacroiliac joint treatment program under the company RoboticSIfuse. The concept of RoboticSIfuse is to create a forum for physicians and patients to identify, diagnose and comprehensively treat SI joint dysfunction. RoboticSIfuse.com is a website intended to identify practitioners specializing in treating SI joint dysfunction and educating patients on this specific problem. The practice utilizes two freestanding ASCs for interventional pain and surgical procedures done minimally invasively with robotic spine technology.
In the last five years Dr. Giovanini has performed more than 3,500 outpatient spine, same day surgeries including one level TLIF and ALIF, up to three-level anterior cervical discectomy and fusions, cervical disc arthroplasty, coflex microdecompressions and multilevel lumbar laminectomies. Sacroiliac dysfunction has been the newest addition to the ASC space performing pain management, neuroablative, and specifically robotic SI fusion procedures. Regenerative medicine has also been recently incorporated to complete the comprehensive package available in the ASC space.
SI joint dysfunction is a growing area of concern, and could make up around 20 percent of the spine market by 2021, according to the North American Spine Society. Dr. Giovanini performs sacroiliac joint fusion procedures using the Mazor Renaissance portable robotic system and Medtronic's Rialto cages. He has performed more than 100 cases in the outpatient setting. His procedures take the posterior approach, rather than lateral, employing threaded cages to allow for immediate fixation and early ambulation with minimal postoperative pain and muscle damage. The robot allows for customization of trajectory for each individualized anatomy and is highly accurate and reproducible.
"The lateral approach can be more painful because surgeons have to access the surgical site through the gluteal muscles which also is a more difficult robotic trajectory," said Dr. Giovanini. "The robotic technology and threaded cage allows us to perform SI joint fusions with the minimally invasive approach in a safe and reproducible way." This makes the procedure safe, efficient and accurate.
The robot in this procedure minimizes radiation substantially to the patient and the staff. "The variances in the anatomy of the SI joint is extremely variable," said Dr. Giovanini. "I could not do it without the robot. The case takes around 25 minutes now and is completely outpatient. Most importantly, I believe any surgeon can do it with minimal learning curve with robotic technology."
Furthermore, "Robotics removes the human error that can occur with fluoroscopy or other navigational systems."
Dr. Giovanini employs the Mazor/Medtronic Renaissance system in the outpatient space due to its low cost and size. The Renaissance system is efficient and cost effective for surgery centers and is time proven highly accurate. He employs the Mazor X for cases at the hospital requiring more complex procedures or for medical necessity.
From a financial standpoint robotic SI fusion is a very successful procedure for SI joint dysfunction and is extremely beneficial to the ASC both financially and from an outcome and complication prospective.
Dr. Giovanini is so confident in the technology and his outcomes that he offers to teach any surgeon — even others in his region — how to use the robotic system for minimally invasive SI joint fusions.
"The learning curve for this technology is super-fast," said Dr. Giovanini. "Everyone knows orthopedics and spine are moving into the outpatient space and surgeons will want a navigation or robotic system to improve outcomes. But it has to be economically feasible. The Renaissance system is feasible to use in the ASC."