Spine surgery through a computer

Spinal surgeries require high precision and speed, which most older methods provided to an extent. The new computer-aided navigation surgery makes the surgeon8217;s job much easier. Dr Yash Gulati, Senior consultant and spine surgeon in Delhi8217;s Apollo Hospital8212; and one of the first in India to use this technique8212;explains how

WHY

There are many conditions which lead to instability of the spine 8212; fractures, degenerative spine, spondylolisthesis etc. When these happen, it is essential to stabilize the spine using various types of instrumentation. The modern way is by using pedicle screws in the lumbar and dorsal spine, lateral mass plate or pedicle screws in the cervical spine and direct repair of fracture at C1-C2. Trying to pass screws in such an important structure is a difficult and sometimes hazardous exercise. Till now, continuous monitoring with X-Ray, fluoroscopy image intensifier was used to guide the surgeon. Although this was a satisfactory technique, it was cumbersome involving moving heavy machines at various steps of the surgery. Also, the accuracy was not 100 per cent. Many times, visualisation has been a problem, especially in obese patients or those who have a porotic spine. Risk of infection also increases. Hazards of radiation to patient and the OT personnel during the prolonged surgery is also an important consideration.

WHEN, HOW AND WHAT

Over the last couple of years, a revolutionary modern technique has been introduced8212;navigation surgery8212;which works almost like the stealth technology of bomber.

In this technique, fixed points are fed into the computer through image intensifier or CT Scan/MRI. A computer memorises this information. Specially made reflecting arrays are fixed to particular points in the patient8217;s spine. These are located by camera attached to the computer, which makes a model of the spine. The model is used to plan and execute and even a dummy operation can be done. It is almost like 8220;instrument landing8221; by an aeroplane.

8226; The actual surgery becomes simple, fast and precise because with a specially made pointer with attached reflecting arrays, the surgeon is able to find out exactly which point of the spine he is on, and can decide the direction, size and placement of the instruments. The errors possible with the earlier technique can now be totally eliminated and damage to vital structures around the spine 8212; nerve roots, dural sac, spinal cord, large vessels 8212; can be altogether prevented. Because it is a guided surgery, the incision is smaller, which decreases side effects and helps patients recover faster.