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Dr. Kim describes how technology has improved the way spine surgeries are performed.
Dr. Kim:
The technology in spine surgery in general is growing at a tremendous pace. In addition to doing a lot of surgeries minimally invasively, we also utilize additional tools in the operating room that we see every day in our daily lives, and I’ll give you an example–most of our cars now, if you buy a car in the last few years they have a GPS system. And I can just tell you that when I drive some place that I have never been to before, if I don’t have that computer navigation system in the car, it is so difficult for me to get to where I want to get to, without having to look at maps and without having the anxiety of knowing how far away I am.
Now imagine you have that same issue in the operating room, and all of a sudden you have a computer navigation system that is on all the time, that tells you at any moment in time exactly where you are, even before you make the skin incision, and that technology that’s been in just about everybody’s new car is just now getting to the operating room. And I can tell you that the technology has been around for a long time and readily usable.
And I use this technology for minimally invasive surgery because even before I make the skin incision, I want to make that skin incision in exactly the right spot so that I can make it as small as possible, and so that I don’t have to stretch the skin one way or the other if I am not over the right spot.
And you can do that by using GPS, and I have a pointer and before I even make the skin incision, I touch it to the skin and I ask the computer to draw a straight line off the tip of it, and I can move it around on the skin until that computer tip, that animated virtual tip gets right over the desired surgical target site. And now I know exactly where the bull’s eye for the skin incisions is.
That way I can make the skin incision really small, and as I go down through the soft tissues, I can just use my finger and just create a little tunnel rather than opening things up. So really a lot of the surgery is done with live fluoroscopy looking up on a computer screen where I can see multiple images on a computer navigation screen, and we also use neuromonitoring.
So if I get too close to a nerve, a lot of leads that are hooked up to the body will tell you, “You are too close to the nerve, you are too close to the nerve.” And having all these technologies available allows you to make the skin incision smaller and smaller and smaller.
Without those technologies, you have to open everything up and look down there so you can see what’s going on, and you really don’t need to see everything that you need to see because usually the surgical target site may be the size of a dime, but without advanced technology the incision has to be the size of a CD ROM case so that you can see everything around there to know where you are, and you don’t need that.
You don’t need anatomy directly visualized and exposed and stripped of all soft tissues to know where you are if you have these other technologies. So I think the use of robotics, computer navigation, neurophysiologic monitoring, intraoperative imaging, live imaging in the operating room will be a key to advancing the field and providing that level of care that patients will come to expect in the not too distant future.
About Dr. Kim, M.D.:
Dr. Choll Kim graduated cum laude from Harvard Medical School and completed his fellowship training in complex spine surgery at the Mayo Clinic. He is board certified by American Board of Orthopaedic Surgeons.
Dr. Kim is a nationally known expert in the modern field of computer-assisted minimally invasive spine surgery. He has trained specialists throughout the country on the safe and effective application of state-of-the-art techniques using image guidance and navigation technologies.