Concise and highly informative slides on recent advancements in spine surgery

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Dr Zishan
Senior Resident
Department of Orthopaedics
Paras HMRI Hospital
Recent advancements in Spine
surgery

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 The rapid advances in technology we have seen in recent
years have also led to exciting discoveries and avenues in
which the field of spine surgery can drastically progress.
 Advanced navigation systems, robotics, various
implant techniques, and innovative technologies
continue to impact the spinal surgery industry.

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Today I am going to elucidate some of current
developments in the field spine surgery:-
 Microscopic minimal invasive spine surgery
 3D navigation-guided surgeries
 Laser guided Spine Surgery
 Robotic-assisted spine surgeries
 fusionless surgery for spinal deformity
 Full endoscopic inter body fusion techniques

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Aim and principles of minimally invasive spine surgery:-
 MISS techniques now have applications in treating traumatic,
neoplastic, infective, and structural pathologies of the entire
spine.
 The key principle that guides MIS approaches is its ability to
minimize muscular injury using known intermuscular planes,
thus treating the pathology leaving the “smallest footprint”
[Figure 1]. The posterior lumbar musculature along with
dorsolumbar fascia is responsible for generating spinal
movements while maintaining stability.

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History and evolution of MIS:-
 Tubular access to the lumbar disc was first reported by Faubert
and Caspart in 1991
 The first description of microendoscopic discectomy then came
from Foley and Smith in 1997.
 Korean Spine Surgeon Anthony Yuong 1999) was first to
popularize the use of transforaminal endoscopic discectomy
through the safe zone of “Kambin triangle” (1990) by inside-out
approach (Yeung Endoscopic Spine System) followed by the
development of interlaminar and outside-in transforaminal
endoscopic techniques by Kim et al.

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Applications of MISS
 :Endoscopic discectomy
 Endoscopic laminoforaminotomy
 Endoscopic C1-2 trans-articular screw fixation Transpedicular
 Percutaneous vertebroplasty/kyphoplasty
 Percutaneous pedicle screw fixations.
 Correction of congenital and adoloscent deformities –
anterior/lateral minimal access- XLIF/ALIF/OLIF with
percutaneous screws fixation

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Continue:-
 Endoscopic assisted excision of excision of spinal tumours
 Intra and extra medullary tumours

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Endoscopic discectomy

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Percutaneous pedicle screw fixation
and TLIF

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Limitation and Drawbacks of MISS
 Increased radiation exposure
 Steep learning curve
 Guide wire-related complications
 Resource intensive
 Superior facet joint violations
 Skill-based reproducibility of results
 Higher implant costIndications
 limited in complex cases

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3D NAVIGATION AND COMPUTER
ASSISTED NAVIGATION SURGERY
 One change within surgical treatment of the
spine was the onset of widespread use of
Computer Assisted Navigation over traditional
fluroscopic assisted technique
 Real Time Navigation in use of Many
intraoperative procedures like spine tumour
resection, correct and acurate placement of
pedicle screws in complex anatomy like C1-C2

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O Arm machine:–
360 degree scanner

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Benefits of using 3D CAN
 Theocharopoulos et al. showed that radiation exposure
for a spine surgeon was 50 times the lifetime radiation
dose of a hip surgeon, highlighting the need to limit
radiation exposure
 Great accuracy and excellent outcome of surgery
 Limited surgery time
 DRAWBACKS/LIMITATIONS:-
 Need of High intra operatablity.
 Not cost effective
 Need proper training for use and management

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Robotic Assisted Spine Surgery:-
Robotic systems have tremendous potential to supplement the skills of
spine surgeons, improving patient safety and outcomes while limiting
complications and costs.
Currently, 3 robotic systems in the United States have been cleared by the FDA for use
in spine surgery:
 Mazor X Stealth Edition (previous models include the Mazor X,
 SpineAssist,
 and Renaissance

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Why Robotics?
Preoperative planning reduces need for
intraop xrays
• Eliminates the error of the human hand
Easy learning curve fo surgeons
Mazor stealth Robotic arm:-

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Advantages of Robotic spine surgery:-
 For Surgeons:-
 Less radiation exposure in OR
 No need to wear lead
 Wearing a 15-pound lead apron can place pressures of up to 300 pounds per square inch of
intravertebral discs
 For Patients:-
 Great outcome of surgery
 Less exposure to radiation
 Minimal soft tissue damage
 Minimisation of chance of injury to neurovascular structure

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Percutenaous laser discectomy:-
1. Percutaneous laser discectomy has been performed on both
cervical and thoracic disc but the numbers are so small as to
make their reporting anecdotal.
2. The advantages of laser discectomy include short recovery time,
it is performed under local anesthesia, it reduces the soft tissue
and bone injury, there is no epidural fibrosis, lessened chance of
creating instability since only a small amount of tissue is
removed,

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Disadvantages of PLD:-
 Disadvantages include the relative expense of the procedure and
inadequate temperature control causing nerve root, vertebral body,
and endplate damage.
 Choy et al.reported the results of 333 patients in whom they
performed laser discectomy with the Nd:YAG laser and obtained
78.4% good results and poor responses for 21.6%. One hundred
and sixty patients experienced immediate pain relief during the
procedure. Choy also reported in another study that there is no
association between outcome and sex, age, duration of symptoms,
or disc level.
 https://youtube.com/watch?v=MRVyD7c3ps8&feature=share

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Fusionless surgery in correction of
spinal deformity
 Conventional fusion treatments in children tend to
shorten the spine further exacerbating trunk
shortening and TIS. In the surgical treatment of
congenital spinal deformities in young children,
while reconstructing the spinal deformity, one
should simultaneously pursue preserving the
growth potential of the vertebrae, improving the
volume, symmetry, and functions of the thorax, and
protecting this

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 Today, employed in the treatment of spinal
deformities of young children, there are 2 deformity
reconstruction methods serving these targets:
Growing rod technique and vertical expandable
prosthetic titanium rib (VEPTR) with or without
expansion thoracostomy.
 motorized using energy provided by a magnetic
system. The second option is to use spinal growth force
to lengthen the assembly; these techniques (Luque
Trolley, Shilla), using a sliding assembly, are known as
growth guidance.

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 Thanks