Safety in Spinal Surgery
Safety in spine surgery has always remained a concern for treating surgeons, patients, and their loved ones. Many of the spine surgeries performed involve placement of devices into the spine in order to stabilize the spine. Such devices may include screws, cages, or artificial discs. Confirmation of proper device placement depends on several methods, including x-ray confirmation, surgical navigation (image guided surgery), pediguard (for pedicle screw placement), and neurophysiologic monitoring.
Neurophysiologic monitoring may be one of the most exciting innovations to come into spine surgery in decades. Think of it, what surgeon would dare operate without blood pressure monitoring? So why operate without nerve monitoring? According to recent data, monitoring reduces the incidence of a poor, even catastrophic surgical outcome by 50 – 60%.
What is neurophysiologic monitoring? It’s putting sensors on the patient that monitor changes in their electrical signals. When performed by a trained expert it will spot changes in brain, spinal cord, and peripheral nerve function before there is any irreversible damage. Correctly performed, monitoring of nerves during surgery can guide the surgeon through a smooth and safe surgery. The monitoring will alert him or her of a stimulated nerve. It can show nerve stress or damage and even pinpoint the location of the irritation.
In our institution, we have been utilizing this modality since the late 90s, and to the best of our knowledge, we are the only institution in Singapore that has routine dedicated neurophysiologic monitoring. In our experience, this tool serves an indispensable safety net for any surgeon manipulating nerves or dissecting within a hair’s breadth of a nerve.
Surgical navigation (image guided surgery). Today, through image-guided surgery (IGS), the spine surgeon is able to see the procedure as it is performed in real time. IGS illustrates how advancements in instrumentation, computer technology, and imaging have been developed to help surgeons perform complex spinal reconstructions safer and faster.
The concepts behind IGS are similar to those in a Global Positioning System (GPS). IGS provides the surgeon image visualization and analysis capabilities during live or 'real time' surgery. Today spinal surgeons are adapting image-guided surgical techniques to many procedures to surgically reconstruct and stabilize the spine.
We are currently renovating our operating rooms to have fully integrated surgical navigation capabilities, and will be fully operational by mid-November 2007.
Pediguard. This is the first and only FDA-cleared device for real-time detection of possible penetration outside the vertebral pedicle. The PediGuard is a drilling instrument that constantly monitors the electrical conductivity of the tissue at its tip throughout the drilling process. PediGuard measures and translates the electrical conductivity into an audio and visual feedback. Its sensitivity allows the surgeon to know whether the tip is in contact with bone, soft tissues or blood. The surgeon is immediately informed through variations of sound cadence, sound pitch and LED flashes, when and if the electrical conductivity at the distal part of the instrument changes--thus helping the surgeon to better control the surgical procedure.
Our institution is the first in Singapore to adopt this technique for our patients, and is the only certified training center in Singapore for surgeons from the region.
Our team of Spine Surgeons are available for consultation daily. For appointments, click here.