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surgical approaches, but you can also use the images to verify proper
hardware placement. It's ideal for surgeons who are moving toward
performing transforaminal lumbar interbody fusions on an outpatient
basis. Only a few surgeons are attempting these cases, but hopefully
more will soon.
I prefer to use a C-arm that lets me switch between 3D and 2D images
mid-procedure so I can seamlessly navigate and assess my progress.
Another popular 3D imaging option, the O-arm, requires surgeons to
take the equivalent of CT scans every time they navigate along the
spine, which subjects patients to increased radiation exposure. While
somewhat large and cumbersome, the O-arm produces high-quality
images, which is essential during certain high-risk cases.
• Tubular retractors
used to access the spine are critical to the suc-
cess of certain minimally invasive approaches, such as far lateral
microdiscectomy involving a Wiltse dissection, during approaches
to the lumbar spine. Many surgeons rely on tubular retractors for
a large variety of surgical procedures.
• Headlights
are especially important during microdiscectomy or
ACDF for surgeons who prefer to forgo using a microscope. Surgeons
want lightweight, comfortable models that let us adjust the intensity
and diameter of the light field.
• Intraoperative neuromonitoring
uses numerous electrophysiologic mon-
itoring modalities for a variety of reasons, including to help identify malpo-
sitioned screws. Loss of transcranial motor-evoked potentials or
somatosensory sensory-evoked potentials during procedures may alert
you to possible complications that might have otherwise gone unnoticed.
Use of electrodiagnostic monitoring during spine surgery is contro-
versial because its efficacy has yet to be proven by Class I clinical
data. In my experience, however, it's a critical component of improved
patient safety and case outcomes, especially involving instrumented
S P I N E
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