Jeffrey R. Carlson, MD, CPE
Since its beginning, spine surgery has been a very technologically advanced specialty. Surgery that involves such precision and delicacy in surgical skills and the confidence in one’s decision making to improve a patient’s neck or lower back function while working around the spinal cord and nerves has always been at the forefront of medical technology. Concurrently, imaging studies to evaluate a patient for a specific diagnosis continued to be improved and refined as the capabilities of our imaging computers and programs have evolved. Deciding on the best surgical treatment for a particular patient’s condition can now be enhanced by this technology, as it allows surgeons to explore the potential treatment options prior to making a definitive surgical decision.
Currently, there are some exciting advances in technology that are changing how spine surgery is performed. Innovations in operating room x-ray machines now allow surgeons to see 3-D views of the patient’s spine in real-time during a procedure. The quality of the imaging is enhanced by the computer’s software’s ability to digitally “remove” the soft tissue on the image and allow me to visualize only the patient’s bone. This technology has made some more difficult procedures technically achievable. This 3-D imaging technology can be paired with computer algorithms that allow the surgeon to manipulate the view of the spine and ensure that the patient’s unique anatomy is completely understood. Better imaging should, in turn, lead to better surgery. As a result, this may also lead to less radiation exposure for the patient and medical team during and after surgery, as surgeons will not need as much x-ray machine use during surgery and may not need to order x-rays or CT scans after surgery.
There are also new advances in the digital-imaging computer applications. As we have seen virtual reality (VR) take gaming to a whole new level, VR is advancing into the area of spine surgery as well. Patients now receive a pre-operative CT scan that can be loaded into advanced computer software that will enhance the imaging for visualization in any view that the spine surgeon needs. The surgeon can see the spine anatomy as the spine images are projected onto transparent glasses that the surgeon wears on a headset. The images overlay the patient’s anatomy, so the surgeon can view the true anatomy and the VR anatomy at the same time. This provides an experience which is like watching a 3-D movie while wearing the glasses. This technology can be paired with instrumentation images and data that allow the spine surgeon to guide the application of screws, rods, plates, and cages to fix the spinal bones. The images can be moved, turned, and rotated to meet the needs of the spine surgeon throughout the procedure.
As with any technological advancement, there can be some drawbacks. You may have heard the phrase, “garbage in, garbage out”. This technology is highly dependent on the data that is fed into the system. If the patient imaging is not accurate, the computer output will not be accurate. The spine surgeon still must have the surgical experience and training to ensure the computer is not giving them a false sense of security. After all, the surgeon is the one placing the pedicle screws into the vertebrae, not the computer. The computer system is a tool that may provide some benefits to the spine surgeon, but the surgeon is responsible for the success of the surgery. The fellowship trained spine surgeons at OSC stay on the leading edge of technology and we continue to pioneer and develop these applications to ensure they are ready for their Premier Presentation in an operating theatre near you.