Dr Arvind Bhateja, Lead Neuro & Spine Surgeon, SPARSH Hospital explains that spine surgery has now evolved to a much more delicate, precise and less disruptive place with the use of intra-operative image guidance using high definition intra-operative imaging of the spine paired with a surgical navigation system
Over the last few decades, spine surgery has rapidly evolved using the most innovative technological advances to fulfil the ever lofty goals of safer surgery that is not only more effective but also least disruptive to the patient.
Many advances such as better imaging through various MRI protocols to better understand anatomy and function, intraoperative neurophysiological monitoring, microsurgical techniques with built in advanced features such as intra-operative angiography are now all part of the neurosurgical armamentarium.
Spine surgery has now evolved to a much more delicate, precise and less disruptive place with the use of intra-operative image guidance using high definition intra-operative imaging of the spine paired with a surgical navigation system. These technologies are great enablers in the pursuit of approaches which are least invasive, navigating complex spinal patho-anatomy culminating in highly satisfactory outcomes in terms of post operative pain, more effective and precise surgery with shorter and quicker rehabilitation.
The human spine in all its complexity has long been a surgical area where any intervention was considered fraught with great risk and poor outcomes. Over the last few years, research and technology have combined to alter this paradigm and shift it into a space where it now is just the opposite. The reasons for these are many but a few of the essential ones are:
- Better imaging- both preoperative and intraoperative
- Use of surgical navigation
- Intraoperative neurophysiological monitoring
- Advances in implant design and technology
- Novel minimally invasive microsurgical approaches to the spine
Of these perhaps the most revolutionary have been the O ARM surgical imaging system paired with surgical navigation. In simple terms, this can be compared to a GPS that one uses in a vehicle. The preoperative images are akin to a map that one refers to on a GPS device. However these maps can change in real time due to various factors such as road closures etc. Hence the maps need real time updation. The use of high definition O Arm imaging in the operating room creates a real time map of the spine. This “map” is seamlessly integrated with an optical navigation system (Stealth S8) that correlates this map to the actual patient in the operating room space using various trackers attached to the patient and surgical instruments. The infra-red camera of the navigation system is similar to a satellite in space tracking a GPS device and placing it on the map. The camera can “see” trackers attached to the patient and instruments, and place this on the map created by the O Arm with a very high accuracy of less than 1 mm.
This high definition three dimensional map of the patient’s anatomy is then used to gain precise keyhole access to the spine using small incisions with very little disruption of normal tissues overlying the spine. In addition it provides high accuracy without the need for the surgeon to visually confirm the anatomy- which is often responsible for disruption of normal tissues.
Finally the O arm surgical imaging system can be used to confirm the placement of implants and the goals of surgery at the end of the surgical procedure thereby greatly reducing the need for a revision surgery.
With this, procedures such as minimally invasive TLIF (transformational lumbar inter body fusion). OLIF (oblique lumbar inter body fusion), ALIF (anterior lumbar inter body fusion), scoliosis correction, MIS fracture stabilisations etc are safe, minimally disruptive and highly effective ensuring shorter recovery times and happier outcomes for patient and surgeon alike.