Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What is the number one thing spine practices should look for in electronic medical records?
lease send responses to Laura Miller at firstname.lastname@example.org by Thursday, Nov. 22, at 5 p.m. CST.
Q: What technology have you been most impressed with over the past year?
Isador Lieberman, MD, Spine Surgeon, Texas Back Institute, Plano: The "ultrasonic bone scalpel" developed and distributed by Misonix Inc., in the words of a recent fellow of mine it is "a game changer." As I have gained experience with it I have been able to take advantage of it's a traumatic method of osteotomising bone for facetectomies, Smith Petersen osteotomies, pedicle subtraction osteotomies and even cervical corpectomies. The device is safe, efficient and provides for a precise cut. It has dramatically enhanced my ability to decompress the spine or release the spine in a less invasive fashion.
Hooman Melamed, MD, Orthopedic Spine Surgeon, Marina Del Rey (Calif.) Hospital: The development & use of minimally invasive techniques on complicated cases with potentially the same benefit as the traditional open techniques.
Trent J. Northcutt, CEO, Aurora Spine: I see a revolution coming in the market. More and more doctors are accepting ISP devices as their implant of choice for treatment of stenosis and for fusion and stabilization. ISP devises offer the doctor a true MIS implant to address the patients back pain. Minimal blood loss, lower infection rate, and shorter OR time.
Jeffrey Wang, MD, UCLA Spine Center: I have been most impressed by the lack of new innovations and new technologies that have not been present at research and society meetings. For the technology that is more recent, I have been impressed with the patients in my practice who have had cervical disc arthroplasty.
Joseph Zavatsky, MD, Section Chief of Orthopedic Spine Surgery, Ochsner Medical Center, New Orleans: Minimally invasive surgery is becoming more prevalent in many spine surgeon's practices but the amount of fluoroscopic X-ray exposure to the patient, the operating room staff and especially the surgeon, since he or she is usually closest to the X-ray generator, has increased. This is a concern over a spine surgeon's career, as the cumulative radiation dose can increase. This increased radiation exposure can result in the risk of a higher incidence of cataracts, thyroid and other cancers to surgeons.
I am very excited about a new product I have just started using for percutaneous pedicle screw insertion called Safe Wire. This unique guide wire can decrease the amount of fluoroscopic X-ray necessary during placement of percutaneous pedicle screws over a guide wire. The unique design of the guide wire is forked or has a "Y" tip that deploys or splays once it exits or is advanced through the distal end of the Jamshidi needle, engaging even the most osteoporotic bone. Once the Safe Wire guide wire is in place, it is next to impossible to inadvertently advance this guide wire through the vertebral body. This can prevent injury to structures anterior to the spine if the guide wire were to be inadvertently advanced through the anterior cortex of the vertebral body, specifically the vessels.
The inability to accidentally advance the Safe Wire guide wire through the vertebral body gives surgeons the confidence to place percutaneous pedicle screws using significantly less fluoroscopic X-ray. This results in less radiation exposure to the patient and OR staff. This is especially true when placing S1 screws, which many surgeons try and place S1 screws bicortically. After tapping the distal cortex of the S1 pedicle screw pilot hole, there is no longer a physical stop to prevent a standard guide wire from advancing anterior to the sacrum possibly injuring the vessels. These vascular structures lay immediately anterior to the sacrum in-line with the S1 screw trajectory.
Utilizing the Safe Wire guide wire technology cannot only decrease the risk of guide wire complications, especially in osteoporotic bone and at S1, but it can reduce the radiation exposure to the patient and operating room staff, including the surgeon.
More Articles on Spine Surgery:
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Goals & Priorities for Spine Surgeons Post Healthcare Reform: Q&A With NASS President Dr. Charles Mick
5 Spine Experts on Most Exciting Technology for Spinal Surgery FeaturedWritten by Laura Dyrda | Friday, 16 November 2012 15:19
Here are five spine surgeons and experts on the most exciting technology for spinal surgery next year.
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