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Modern Day spine surgery – Safe, Accurate and Effective

The image illustrates the recent technology used in spine surgery.
Published by Dr. Umesh Srikantha on May 24, 2020

Spine surgery has always carried with it the myth of being unsafe, risky, dangerous and needing a long time to recuperate and get back to normal activity thereafter. Many people have refused spinal surgery owing to this misconception and the general neighborly or well-wisher advice always given is to avoid one, even when it is unavoidably essential.

Spine surgery is often advised either for pain relief or improvement/ preservation of nerve functions in the limbs. In either of these cases, spine surgery should be specific and targeted to achieve the desired objectives of surgery without compromising the function of the nerves or the integrity of the spine. These objectives, though simple said, are not that easy to achieve; and a surgeon, apart from his skills, would need the assistance of modern equipment and advanced technology to offer extremely good outcomes in even the complex of cases.

Presence of each of these technology or technique adds to the safety and accuracy of spinal surgeries and improves outcomes with faster recovery times.

Advances in Technology:

Intraoperative Neuromonitoring (IONM): As the name suggests, this equipment is used to monitor the function of the nerves during the surgery, so that it can identify any inadvertent injury or compromise to the spinal cord or nerves during surgery, even if the surgeon is not aware of it. By recognizing such a misadventure, a surgeon can adopt corrective steps or withhold the procedure to avoid any further damage. In essence, IONM allows the surgeon to operate within the safety limits, thus making the surgery safer.

Image describes neuromonitor for the spine.

Intra-operative Navigation: This works in a similar principle of navigation systems in your car/ phone. It allows the patient’s anatomy to be linked to the surgical instrument, so that the surgeon can exactly determine the position or direction of the instrument. This makes the surgery more accurate.

Doctors are monitoring the monitor during spine operation.

Intra-operative 3D imaging: Conventional intra-operative imaging always consisted of a 2D image (classically called C-arm), which is like taking an x-ray during surgery. However modern intra-operative imaging techniques can acquire 3D images during the surgery (an example being the “O-arm”®), which is like taking a CT scan during surgery. As expected a 3D image gives more information about the disease and the patients anatomy and makes the surgery more safe and accurate. By combining with Navigation, it also helps the surgeon to specifically target the diseased area and navigate the instruments with an extremely high level of accuracy and confidence, even when the anatomy is distorted or complex.

3D image of O-arm.

Advances in Technique:

Minimally Invasive Spine surgery (Keyhole surgery) – In the present day, almost all of the cases that need spine surgery can be done with a minimally invasive technique, which is based on the principle of causing reduced injury to the supporting structures of the spine (the muscles and the ligaments) which are just innocent bystanders that otherwise are subjected to injury during a conventional open surgery. It also offers several advantages like reduced blood loss, lesser post-operative pain, faster recovery and return to work, all accomplished with a small, cosmetic incision.

Image of the tool used in spine surgery.

Full Endoscopic spine surgery – This is the least invasive form of spine surgery applicable to few common condition of the spine wherein the entire surgery is performed through a small endoscope that is less than a centimeter in diameter. One can thus infer that the incision is much smaller and tissue disruption is much lesser, even than Minimally invasive spine surgery. Some of these surgeries can even be performed under local anesthesia and as a daycare procedure.

The Image of an endoscopic spine surgery.


Dr. Umesh Srikantha

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