- MedOne Spine
Outcomes in Navigated Spinal Surgery, Selected From Navigation and Robotics in Spine Surgery, Alexander R. Vaccaro, Jaykar Panchmatia, David Kaye, and Srinivas K. Prasad, 2020Source: Vaccaro A, Panchmatia J, Kaye D et al., ed. Navigation and Robotics in Spine Surgery. 1st Edition. Thieme; 2019. doi:10.1055/b-006-163747Comment: This chapter reviews the major outcomes observed in modern spine surgery using navigated technologies. The aim of this chapter is to critically analyze current radiographic, clinical, surgical, patient-reported, and financial outcomes in computer-assisted navigated spine surgery compared with conventional fluoroscopic techniques. Another chapter will describe outcomes in robotic spine surgery. Navigation in spine surgery may be considered as an adjunct for optimizing surgical outcomes. However, a firm understanding of the anatomy and surgical skills needed for more conventional techniques remains important to the modern spine surgeon. Pedicle screw insertion with navigation has largely been shown to be more accurate and requires less time than conventional freehand techniques. Navigated spinal surgery decreases radiation exposure to the surgical team. Operative times in navigated spine surgery have shown noninferiority metrics when compared to conventional methods. Perioperative complications and patient-reported outcomes may require additional studies to better understand the complex interaction of navigation techniques and associated outcomes. Early comparative studies indicate less blood loss and the potential for decreased neurovascular intraoperative complications resulting from more accurate instrumentation placement. Some of the limitations and challenges seen in navigated spine surgery include high acquisition costs of the equipment, the learning curve for surgeon and healthcare team, and unique risks associated with the technology.
Chapter 3 - Cervical Radiculopathy, Selected From Video Atlas of Spine Surgery, Howard S. An, Philip K. Louie, Bryce Basques, and Gregory Lopez, 2020Source: An H, Louie P, Basques B et al., ed. Video Atlas of Spine Surgery. 1st Edition. Thieme; 2020. doi:10.1055/b-006-164722Comment: There are two main etiologies of cervical radiculopathy: (1) degenerative cervical spondylosis and (2) disc herniation. Many conditions can present with symptoms similar to those observed in cervical radiculopathy. A careful examination should be carried out to identify the pathologic nerve root level. However, it is important to remember that there can be a cross-over between myotomes and dermatomes in presentation. Nonsurgical/Conservative management is generally the first line of treatment as the natural history of cervical radiculopathy is generally considered favorable, without progression to myelopathy. Patients are generally indicated for operative intervention if conservative treatment has failed to relieve neurologic deficits or radicular symptoms or if there are signs of progressive root/cord dysfunction. Depending on the pathology, surgery can be addressed either anteriorly or posteriorly. Anterior cervical surgery allows for a muscle-sparing approach, allows for direct removal of anterior pathology without direct retraction of neural structures, and can be utilized in patients with a kyphotic deformity. However, complications include dysphagia, hoarseness, vertebral/carotid artery injury, dural tears, or esophageal/tracheal injury. The posterior approach can be performed through minimally invasive techniques. It allows for direct access to the posterior longitudinal ligament (PLL), and for decompression-only procedures without significant destabilization of the cervical spine. With either an anterior or posterior approach, success rates are high when decompressing cervical nerve roots for radiculopathy.
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