Minimally Invasive Spine Surgery
Posterior Spinal Fusion with pedicle screw and rod instrumentation using minimally invasive techniques
Minimally invasive surgery requires 3-Dimensional registration of the patient's body. Once this is done, image navigation can be used to localize and identify anatomical structures for strategic placement of instrumentation typically used in a posterior spinal fusion.
These cases are not different from a posterior spinal fusion in that the same modalities are monitored, it's just that there isn't a lengthy exposure time through tissue. Monitor these cases as though you would any posterior spinal fusion.
The steps that are taken: The surgeon will surgically place an antenna used to collaborate with the O-arm and navigation equipment. O-arm fluoroscopy is taken for localization and 3-dimensional visualization of the surgical field. Localization is just like C-arm, you should have lead with a thyroid shield available to wear and keep your distance from the equipment. When the O-arm spin is taken, This typically puts off a lot of radiation and one should leave the room, monitoring of SEP on a timer can be used, one should stay close and monitor the equipment.
After the O-arm spin is taken the visual field is registered with the navigation equipment and the surgeon begins to place canulas and k-wires to pilot the placement of pedicle screws which are placed over the k-wires. The placement is verified through navigation. Monitor just as you would any other surgery, looking for any EMG and correlating MEP stimulation after each significant placement to notice any change. Keep your upper extremity SEPs on a 10 minute timer.
Instrumentation is complete after the rods are set into position and anchored with set/locking screws. There is a characteristic audio feedback of a twisting and locking sound. At this point instrumentation is complete. Instrumentation should be confirmed in position with fluoroscopy and then steps to begin closing will be taken.
These cases are not different from a posterior spinal fusion in that the same modalities are monitored, it's just that there isn't a lengthy exposure time through tissue. Monitor these cases as though you would any posterior spinal fusion.
The steps that are taken: The surgeon will surgically place an antenna used to collaborate with the O-arm and navigation equipment. O-arm fluoroscopy is taken for localization and 3-dimensional visualization of the surgical field. Localization is just like C-arm, you should have lead with a thyroid shield available to wear and keep your distance from the equipment. When the O-arm spin is taken, This typically puts off a lot of radiation and one should leave the room, monitoring of SEP on a timer can be used, one should stay close and monitor the equipment.
After the O-arm spin is taken the visual field is registered with the navigation equipment and the surgeon begins to place canulas and k-wires to pilot the placement of pedicle screws which are placed over the k-wires. The placement is verified through navigation. Monitor just as you would any other surgery, looking for any EMG and correlating MEP stimulation after each significant placement to notice any change. Keep your upper extremity SEPs on a 10 minute timer.
Instrumentation is complete after the rods are set into position and anchored with set/locking screws. There is a characteristic audio feedback of a twisting and locking sound. At this point instrumentation is complete. Instrumentation should be confirmed in position with fluoroscopy and then steps to begin closing will be taken.