Spine Navigation and Neuro-monitoring

A Friend of Safe & Secure Spine surgery

Spine navigation or Computer assisted surgery or Computer-based navigation systems provide a safe environment for minimally invasive spine surgeries or surgery of spine fracture & deformity.

In this procedure need three steps

1. First making of an accurate 3D image model of patients spine. Most effectively this can be done by “O” arm system, which is a real time 3D scanner used in operation theatre.

2. Transfer of this image to computer based navigation system working station .

3. Verification of spine navigation instruments and navigate these instruments on the 3D Image model .

Using spine navigation system, one can navigate spine instruments preciously and real time. This gives a safe environment for doing a spine surgery.

Where navigation system used?

Spine navigation system used in most of the case of spine surgery where needs spinal instrumentation. This is mostly helpful in

1. Spine fracture fixation

2. Correction of deformity like scoliosis, kyphosis etc.

3. Instrumentation in the place where complex  spine anatomy like upper cervical spine, cervicodorsal junction etc.

4. In minimally invasive spine surgery

5. Advance grade of spondylolisthesis

Is navigation really necessary?

A spine surgeon doesn’t need navigation. Just like you don’t need a GPS to get from A to B. You can use a map or memorize your route before you leave. But a GPS provides so much more than just directions. It tells you which way is the fastest. Which route to take to avoid obstacles. And it lets you know if you’re going to turn onto the wrong street.

Intra Operative Neuro-monitoring

Intraoperative Neuromonitoring (IONM) protects patients by continuously monitoring the central nervous system (the brain, spinal cord, and nerves) when it is at risk during surgery.

Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk for injury. Neuromonitoring provides an opportunity to assess the functional integrity of susceptible neural elements during surgery.

Why Neuromonitoring is essential in spine fracture or deformity correction surgery?

In spine deformity or spine fracture surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres.

Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected.

Intraoperative neuromonitoring is the most effective and only  way to recognize this type of neural injury during surgery time and gives maximal opportunity to correct it.

Neuromonitoring--- a most trustable friend of spine deformity correction

Expectations of patients undergoing correction surgery for spinal deformity have been shifting toward the ideal spine shape. In most cases, surgeons can meet those expectations with new surgical techniques, improved spinal implants, perioperative care, safer anaesthesia, invention of cell saver, etc. Unfortunately, with more extensive surgeries, the intraoperative risk of spinal cord injury increases. This neurologic injury may occur due to direct mechanical force applied to the spinal cord (implants, instruments, bony structures), or due to indirect ischemic changes. Quick identification of impending spinal cord injury opens the window of opportunity to the surgeon and anaesthesiologist to act before the injury becomes irreversible. Therefore, the monitoring of gross motor and sensory function in spine deformity surgery is extremely important, especially when correcting spine deformities in the paediatric population presenting with additional neurological risk: neglected rigid kyphoscoliosis, congenital spine anomalies, revision spine surgeries, spine fracture fixation, etc.