Technology Leads to Promising Outcomes for Neurosurgery


June 13, 2013

Topic: Neurosurgery - Andrews Institute Spine Center

Reichwage O-arm Spine Surgery

Advances such as the O-arm technology help to ensure more promising outcomes in spinal neurosurgery.

Spinal neurosurgery has come a long way in the past few decades and is one of the fastest-growing divisions of the $17 billion global orthopaedics sector, according to Biomedical Business and Technology. Today technologies, such as the O-arm® interoperable imaging platform allow experts in the field to treat a large range of disabilities and improve the quality of life for many patients.

"The spine should be considered holistically as its own organ system with a unique anatomy, physiology and pathology," said Brett Reichwage, M.D., neurosurgeon at the Andrews Institute.

The spinal cord is encased by a tunnel of discs and bones called vertebrae that allow individuals to stand and bend. However, these bony projections, as well as the surrounding tissues, are prone to problems that may cause damage or change the structure of the spine. Some of the potential issues include infections, injuries, tumors, conditions such as ankylosing spondylitis and scoliosis, as well as bone changes that occur from the natural aging process such as herniated discs, according to the National Institutes of Health.

Any problem that affects a patient’s spine could cause discomfort if it causes vertebrae to put pressure on the spinal cord or nerves, and may decrease mobility. Treatments of spinal conditions vary. Physicians must tailor care plans to each patient’s ailment as well as the goals to which he or she is working toward.

Minimally Invasive Procedures

If surgery is the answer, intervention can range on the spectrum of maximally to minimally invasive. Large scoliosis corrections usually require maximally invasive surgery while the majority of spine operations for pain can be done through minimally invasive techniques.

“The most important and difficult challenge of spine surgery is tailoring the best operation for a given individual,” Dr. Reichwage added. “The underlying pathology must be understood and the patient’s overall health, bone quality, history of prior spine surgeries and pain generators are key players in shaping this decision making process. Tailoring an operation with the greatest chance of creating an excellent surgical outcome is what I focus on providing every patient.“

Minimally invasive spine surgeries were first performed in the 1980s, but recently have become more popular, according to the American Association of Neurological Surgeons. This type of procedure is less disruptive to the muscles that surround the spine and therefore may result in faster recoveries and less blood loss during surgery.

Minimally invasive spinal surgery techniques include from simple decompressive surgeries to instrumented fusions. In general, they are performed through smaller incisions and the surgeon accesses the relevant anatomy through hollow, tubular tools.

New Possibilities

One tool that neurosurgeons can use for both maximally and minimally invasive procedure is intraoperative CT imaging through O-arm technology to guide instrumental placement. In fact, it is currently the most precise and accurate method available, as it ensures that implants are positioned perfectly.

O-arm technology is a multi-dimensional surgical imaging platform that can be beneficial to surgeons performing spine, orthopaedic and trauma-related surgeries. It uses real-time intraoperative CT imaging that is high resolution and provides views in every direction that allow the surgeon to visualize the patient’s anatomy during instrumentation placement.

There are several advantages to O-arm technology. For example, the innovative technology allows neurosurgeons to maximize the best placement of spinal instruments, execute surgica goals and safely place instruments around the spinal cord, nerve roots, aorta, vena cava, lungs and heart. Additionally, once the instruments are placed, this technology confirms that the implants are perfectly positioned by performing a confirmatory CT scan before the wound is closed.

In the past, surgeons have used pre- and post-procedural X-rays, which exposed patients to higher radiation dosages than interoperable imaging with O-arm technology. Moreover, X-rays superimpose all portions of the anatomy into one picture, while CT – the superior imaging modality to view bony detail – produces three-dimensional visualization.

So far, only about 200 hospitals in the U.S. have acquired the O-arm technology since it was put on the market in 2003, according to the San Fernando Valley Business Journal. These facilities know that the technology increases the scope of what can be considered minimally invasive, and allows for greater precision, safety and accuracy for more complex surgeries.


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