taken in the OR. Lack of adequate visualization is sometimes a techni-
cal issue; the C-arm is simply not producing images that are clear
enough to discern individual discs.
Surgeons can't change a person's body habitus or the technical qual-
ity of the C-arm they're using in the OR. They can, however, plan in
advance of scheduled procedures to ensure they're working with the
best possible image in the OR. If a patient is obese or has pathology
that might create problems in getting a usable image, surgeons could
request to use the best performing C-arm in their facility. They could
also consider having a localized marker placed before surgery at the
bone they're going to treat.
This pre-operative localization is very helpful for procedures that
are in particularly challenging anatomic areas. For example, my
patients who are scheduled for thoracic spine procedures visit a radi-
ologist to get a full-body X-ray or CAT scan. During the imaging ses-
sion, the radiologist places a small coil into the disc that needs repair
or removal, so I don't have to count to the correct spot in the OR. I
simply capture an intraoperative image to locate the coil and there-
fore the intended surgical site.
4. Invest in surgical navigation
The superior image quality provided by surgical navigation technolo-
gy can further reduce the likelihood of wrong-site errors occurring.
The platforms are expensive and there's a learning curve to operating
them proficiently, but the 3D views help to ensure your team is work-
ing on the right disc. These imaging systems allow for another level
of safety that eliminates the scenario of not being able to capture
high-quality intraoperative images, even when operating on a patient
with a suboptimal body habitus.
I use 3D navigation for challenging posterior cervical spine surger-
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