reach the spine
through a 2- to 3-inch
incision. The
approach allows for
minimal dissection of
muscle and tissue, and limited disruption of the underlying retroperi-
toneal organs.
Joseph Blythe, MD, a fellowship-trained spine surgeon in Nashville,
Tenn., performed the city's first OLIF 2 years ago. He says placing per-
cutaneous screws under radiographic guidance is not difficult from
the anterior or posterior approach, but doing it with the patient in the
lateral position is nearly impossible.
"There's a big push to do outpatient 1- or 2-level fusions from a sin-
gle position," says Dr. Blythe. Robotic-assisted, image-guided technol-
ogy helps him accomplish that goal. "Using the robot is like placing a
guided drill bit anywhere on the spine," says Dr. Blythe.
Before procedures, he orders a CT scan, which shows the architec-
ture of the spine, including bony elements and distances between ver-
tebrae. That information is uploaded into the image guidance soft-
ware, which lets Dr. Blythe pre-plan down to the millimeter and pitch
in the bone where he'll place every pedicle and cortical screw. During
surgery, he can then place the screws exactly where he intends and at
a specific pitch in the bone with minimal fluoroscopy guidance.
• Increased cervical mobility. Artificial disc technology increases
spine mobility and puts less stress on adjacent discs. "The latest discs
have changed how I approach disc replacement surgery because
patients do so well afterward," says Dr. Blythe. "It's difficult to find
reasons not to do it. Patients present with herniated discs or stenosis
at one or two levels, and two weeks later they're back at work with
no pain or symptoms."
N O V E M B E R 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 5
Outpatient spine presents
clear value in health care.
— Matt McGirt, MD
