Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 2 of 8 in Advances in Spinal Surgery Technology
The Technology Behind Modern Spine Surgery
May 26, 2024
Modern spine surgery relies on a stack of imaging and safety technologies working together in the operating theatre, not just a single tool.
Imaging, neuromonitoring and magnification
3D CT imaging inside the operating theatre allows surgeons to take a CT scan of the patient during surgery itself. Neuromonitoring involves placing electrodes to pass current and track nerve signals throughout the procedure, functioning as a continuous electrical safety check that nothing is being harmed. High-powered microscopes provide five to ten times magnification with strong illumination for safer, more precise surgery.
Navigation and robotics
The most recent additions are navigation and robotic systems, which allow close to 100% accuracy in spine surgery. Around 90% of spine surgeries today are performed as minimally invasive procedures, through small cuts rather than large open incisions, resulting in less pain and much quicker recovery.
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Principal Director & Head, Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Puneet Girdhar taught doctors across Africa on May 26, 2024.
FROM THE LIVE Q&A
Dr. Kavele
Why is spinal arthrodesis still the technique of choice when a majority of patients who benefit from it develop vertebral listhesis (adjacent-level problems) after years?
Dr. Puneet Girdhar
It is by far the best solution science has invented so far. Vertebral listhesis develops in some patients, not the majority - of around a thousand operations a year, only a small subset develop problems at another level. Just because a surgery might cause a problem many years down the line doesn't mean a patient in pain and unable to walk today should be denied its benefit now - the same reasoning applies to a liver transplant, which is offered even knowing it may extend life by only five to ten years.
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Frequently Asked Questions
Given that a normal disc diameter is around 14-20mm, what is the limit at which surgery is needed - for example, for someone with only 7mm who is still working?▼
Don't measure the millimetres, measure the patient's symptoms. Surgery depends on the patient's symptoms and what treatment has already been tried, not on the measurement alone. If medicine and physiotherapy haven't relieved symptoms, surgery to extend the fusion may be needed regardless of the exact disc height.
What are the new advancements for conditions like quadriplegia in the cervical spine?▼
The first step with quadriplegia is always to find out the underlying cause. Once the cause is identified, it can potentially be addressed and removed.
What would someone need to do to become your assistant?▼
Rather than becoming an assistant, doctors can partner through Jivo's training programmes, which bring fellows from Africa to train directly - the framing is colleague and partner, not assistant.
Does nutrition play any role in spine health, and is a nutritional deficiency a risk factor for developing spine problems?▼
The spine is made up of three main components, each with its own nutritional needs: bones need calcium, vitamin D and sunlight; muscles and tissues need exercise and good protein in the diet; nerves need exercise and vitamin B12. Altogether, a good lifestyle, diet and exercise are what keep the spine healthy.
At what point can we say scoliosis bracing has failed and surgery is indicated? Also, for the interbody cage, can long plates not be used instead?▼
For idiopathic scoliosis, once the curve goes beyond 40 to 45 degrees, bracing has failed and surgery is indicated. On plates: long plates such as Steffee plating are no longer used - for the last 15 to 20 years, the standard has been transpedicular screws with a titanium or PEEK cage instead.
What technologies are used in modern spine surgery?▼
Intraoperative 3D CT imaging, neuromonitoring (electrodes tracking nerve signals throughout surgery), high-magnification microscopes, and navigation/robotic systems.
How much of spine surgery today is minimally invasive?▼
Around 90%, performed through small cuts rather than large open incisions, resulting in less pain and quicker recovery.
In This Series: Advances in Spinal Surgery Technology
- 1.Advances in Spinal Surgery Technology
- 2.The Technology Behind Modern Spine Surgery
- 3.Robotic Spine Surgery: Accuracy and Outcomes
- 4.Minimally Invasive Surgery for Disc Herniation and Spinal Stenosis
- 5.Scoliosis: Warning Signs and When to Brace or Operate
- 6.Complex Spine Reconstruction: TB Spine, Revisions and Delayed Referral
- 7.Bringing Minimally Invasive Spine Surgery to Resource-Limited Settings
- 8.Spinal Fusion, Symptom-Based Surgery Decisions, and Spine Nutrition