Spine navigation allows for more precision and opens more procedures to minimally invasive approaches.
Using 3D, computer-generated spine navigation systems to position implants has transformed spinal surgery. Not only can we place the spinal implants with greater precision, navigation has allowed us to perform more surgeries using a minimally invasive approach.
Minimally invasive surgery means smaller incisions, less muscle dissection, shorter hospital stays, less narcotics use, and a quicker return to work and everyday activities. Patients who undergo minimally invasive procedures also have potentially better long-term function.
With traditional open spine surgery, we rely on bony landmarks to put screws in the right place. To see the landmarks requires a much bigger incision and exposing a much more extensive segment of the spine. Computer-assisted spine navigation means we don’t need those landmarks. The computer is showing us exactly where to put the implants.
Using traditional freehand techniques, implants are malpositioned 5% to 10% of the time. These screw malpositions can lead to new radiculopathy and potential return to the operating room. The new navigation technology reduces the risk of malpositioned implants to less than 1%, improving safety. As evidence of this, we’re hardly ever seeing patients coming back in with new leg pain because a pedicle screw or other implant was placed in the wrong position.
Spine navigation means smaller incision, less muscle dissection
One common procedure is the transforaminal lumbar interbody fusions (TLIF). We used to do TLIFs by stripping all the muscles off the affected area of spine to remove an intervertebral disc before fusing the vertebrae. With computer-assisted guidance, the incision is half the size, and muscle dissection also is reduced by half. The same is true for fusions done anteriorly, where we have less invasive versions of anterior fusion, oblique lateral interbody fusion (OLIF) or extreme lateral interbody fusion (XLIF). All of these less-invasive procedures have been greatly facilitated by surgical spine navigation.
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Smaller incisions also mean less blood loss, which means we can perform spine surgery on older patients who are at higher risk from blood-loss complications.
Limited muscle dissection results in much less immediate pain for the patient, lowering their need for narcotics right away. We’re also able to wean patients off narcotics a lot faster than we used to.
Another benefit of minimally invasive surgery is less time in the hospital. Patients typically leave the hospital a day or two after surgery, instead of the traditional three-day stay.
Minimally invasive surgery also means a faster recovery, with less rehabilitation. In four to six weeks, patients who undergo minimally invasive surgery can be as far along in their recovery as they would be after three to six months with traditional, open spine surgery.
Minimally invasive surgery is not for everyone. For example, patients who have extensive scar tissue from multiple prior surgeries generally are not candidates for minimally invasive surgery.
Those patients who do get minimally invasive surgery tend to be very happy. Surgery is more predictable and less painful, and they are able much more quickly to get back to where they were before.
Mladen Djurasovic, M.D., is an orthopedic spine surgeon with Norton Leatherman Spine.