How computer navigation fits into spine practice today


Here two spine surgeons discuss the use of computer navigation in spine surgery.

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 biggest way in which independent spine practice has changed in the last decade?

Please send responses to Anuja Vaidya at by Wednesday, Sept. 5, at 5 p.m. CST.

Question: What are some of the latest trends in computer-navigated spine procedures?

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Recently, I performed the first O-Arm and Stealth navigated instrumented case at my main hospital. While this is older technology and maybe a long time coming it was great to offer this to my patient. More and more community hospitals are acquiring intraoperative imaging and pairing it with intraoperative navigation. The tech goes hand-in-hand.

In other areas of Los Angeles, we have seen the "rise of the machines" with spinal robots popping up all over. We are seeing community hospitals vie for patients by getting the latest tech, in hopes of recruiting young surgeons and competing for patients. What they do not seem to remember is that building it will not make the patients come. Hospital systems are much better off spending their dollars on supporting local community surgeons who are already doing the work in the area, figuring out mutually beneficial relationships and keeping their surgeons and patients in the fold. They would be spending less money teaching these surgeons how to use this tech rather than recruiting fresh grads to the area and trying their darnedest to get them up and running.

Instead, feed existing practices, so that they grow and can bring in their own talent — with a built-in mentor-mentee relationship rather than foster enmity by constantly bringing in employed physicians who are seen as competition by existing surgeons.

Mark M. Mikhael, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): Spine surgeons now are combining the current CT navigation systems with robotics. The goal is to increase surgical accuracy in deformity and complex spine procedures. We are looking closer at how merging the two technologies will help with device and implant placement. Currently, what we're seeing is exciting, but it is not quite there yet. The robots can be temperamental. We still calibrate the system, oversee it and override it, when needed. But we are moving toward the day when the CT/robot combination plays a greater role in the operating room.

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