July 6, 2018
There are several technologies that are available in assisting the surgeon to accurately place hardware in the spine in addition visualization of the anatomy. These include neurological monitoring, the use of intra-operative X-ray, and the computer assisted spine surgery often known as spinal navigation.
Neurological monitoring involves checking the peripheral nerve, spinal cord, and brain function during a surgical procedure. A technician who specializes in monitoring the nerves places small needles into the various muscle groups and the scalp once the patient is asleep. Under anesthesia, the functions of the nerves can be watched on a computer monitor to make sure the hardware is not too close to a nerve, the spinal cord and brain function is safe, and patient positioning is safe.
Intra-operative X-ray has been used for a long time to help localize the proper area for surgery, placement of hardware, and improvement of a deformity. There is radiation exposure both to the patient and to the OR personnel. Precaution is taken to avoid excessive radiation exposure.
Computer assisted surgery is a technology that has been available for many years but with improved software and X-ray technology the interaction between anatomy and the physician has become more accurate. Current technology prevents the need for a pre-operative CT scan by utilizing intra-operative 3D imaging. An intra-operative 3D image is obtained of the operative field using a minimal amount of X-ray. This then communicates with an infrared camera so that a surgeon can see a digital roadmap of the spine. The surgeon is able to track in real time the position of surgical implants and instruments in relation to the patient’s anatomy for accurate placement of hardware. The surgeon can also plan the appropriate position, length, and diameter of the screws for patient safety. In addition, there is an overall reduction of X-ray exposure to the patient and OR personnel by decreasing the number of images necessary to place hardware. The surgeon can use this technology to treat a variety of spinal conditions including degenerative disc disease, spinal stenosis, scoliosis, spondylolisthesis, and fractures.
Robotic Surgery in the spine as well as the use of Predicitve Analytics and Artificial Intelligence is still in the infancy.