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Presenter discusses use of navigation in spine surgery for accurate pedicle screw placement
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BELFAST, Northern Ireland — Use of navigation for spinal surgery can help spine surgeons accurately place pedicle screws and insert screws in the most optimal position to avoid damage to the bone and adjacent structures, according to a presenter here.
“[Navigation] has been shown that it reduces the number of pedicle screws breaching, it reduces the screw pull-out [and] it reduces our complication rate,” Andrew O’Brien, MD, MBBS, FRCS, said during his presentation at the British Orthopaedic Association Annual Congress. “I think that navigation should be an essential part of our armamentarium as the pedicle finder.”
He added, “Navigation has enhanced our ability to visualize the anatomy. It allows us to find pedicles that we cannot see with other techniques; it allows us to define the anatomy; it allows us to compensate for missing pedicles for bone loss; it allows us to work around existing metal work; and it allows us to take a bone scalpel and make precise cuts within the bone and take out bone in exactly the size we need it. Navigation is extending our range of abilities.”
O’Brien said patients may have difficult or abnormal anatomy, with the possibility of distorted or absent traditional landmarks. In these cases, intensified images are limited in what these can show.
“Navigation allows us to have a clearer image of the abnormal anatomy that plain radiographs or image-intensified [scans] allow, but it also allows us to explore the anatomy on a screen in real-time [and] on a table with the patient in front of us and to use [a] computer simulation to plan,” O’Brien said.
Navigation not only helps with the identification of bony structures, but it can also help surgeons preserve soft tissue. O’Brien noted that navigation allows spine surgeons to “recover and retrieve” situations in which surgeons using conventional techniques would put in a large pedicle screw and not get an optimal hold.
“Navigation gives us another extension to our augmentation. Instead of throwing away the pedicle at that level and find some alternative fix, we can utilize that by being able to put a pedicle screw with an optimal hold around an existing problem,” he said. – by Monica Jaramillo
Reference:
O’Brien A. Are the outcomes of spinal surgery better with spinal navigation? Presented at: British Orthopaedic Association Annual Congress; Sept. 13-16, 2016; Belfast, Northern Ireland.
Disclosure: O’Brien reports no relevant financial disclosures.