In the past, conventional spinal surgery was performed and began around the early 1900s. This follows the use of general anesthesia, emerging of an x-ray machine and has a better antibiotics. The first conventional discectomy was performed and recorded in 1932. The first magnetic resonance imaging (MRI) was used in 1977, which can study the structures inside the spine, including nerves and spinal cord. Surgery in the past is very different from the present.

At present, spinal surgery is modern and uses advanced technology to assist surgeons in performing the surgery to ensure patient safety during surgery, less tissue injury and faster recovery.
 

The latest technologies used today:

1. Endoscopic spine surgery

The surgery is performed through working channel with lens at the tip of endoscope. A water irrigation system is used to improve visibility during surgery and reduce blood loss from surgery. The surgical wound is about 1 centimeter and hospitalized for 1 night after surgery. It can be treated in 2 main diseases, which are the most common degenerative diseases of the lumbar spine. 

1. Herniated disc 
2. Spinal stenosis

Patients who have undergone surgery often come with symptoms of nerve compression; sciatica, hip pain
radiating down the leg, numbness or weakness


2. Minimally invasive spinal fusion surgery

Nowadays, the use of technology to assist in pedicle screw fixation and/or lumbar interbody fusion(disc spacer insertion) with small incisions and holes to insert the spinal implant from the back. This is often used in patients with spondylolisthesis or degenerative disc disease. Patients often come with severe back pain and/or in combination with symptoms of nerve compression; sciatica,  hip pain radiating down the leg, numbness or weakness

Currently, there are 2 main surgical methods. 

1. Minimally invasive-Transforaminal lumbar interbody fusion(MIS-TLIF): Surgery to insert a disc spacer and insert pedicle screw fixation from the back (MIS-TLIF) through a small and stab skin incision and also could do nerve decompression under microscope.
2. Oblique lumbar interbody fusion (OLIF)/Extreme lateral lumbar interbody fusion (XLIF): Surgery to insert a large disc spacer from the side of the patient and insert pedicle screw fixation from the back through a small and stab skin incision.

 

3. O-arm navigation in spine surgery

The O-arm navigation system is a computerized 3D navigation system that scans the spine during surgery(Computerized tomography(CT) based image). This system creates images of the spine in both 2D and 3D images, able to see the structure in every angle of the spine during surgery in real time to help the surgeon during surgery. This will increase accuracy and safety especially for minimally invasive spine surgery, help for insertion of pedicle screw, insertion of disc spacer for lumbar interbody fusion, and help in complicated spine surgery that require high precision.
 

4. Intra-operative neuromonitoring

It is a tool to evaluate the function of nerves and spinal cord during surgery. It requires specialized experts to interpret the results. It is often used in high-risk surgery or surgery to correct spinal deformities such as scoliosis.

 

Technologies that may be used more in the future

1. Virtual reality (VR)/Augmented reality (AR) in spine surgery

Still in the development stage. It is a technology that is a 2D/3D visual representation, especially of the spinal structure during surgery, which may be viewed through unique glasses or displayed through an imaging screen.

2. Robotic-assisted spine surgery

The system is continuously being developed. The current use is the use of a mechanical arm to determine the position where the pedicle screw is inserted into the spine. It is like navigating by driving without a driver, is something that must be pursued in the future.

In conclusion, spinal surgery today is very different from the past. It is continuously evolving.  At present, modern technology is used to assist in spinal surgery to help make surgery safe and to make the surgery to be minimally invasive and minimal tissue injury. The choice of appropriate technology depends on the expertise of each surgeon, and the treatment of each patient is different depending on the condition and disease.


Compiled by Dr. Pritsanai Pruttikul
Orthopaedic and spinal surgery specialist