Issue link: https://viewer.e-digitaledition.com/i/320514
Planning software loads preoperative X-rays onto a computer and allows spine surgeons to assess the spinal anatomy and identify the necessary degrees of correction. The need for osteotomy is also gauged. At the culmination of the planning process, the software develops a prospective rendering of what the spine will look like postoperatively. At times Drs. George and Vaynman use lateral access approaches to perform minimally invasive fusion, accessing spinal deformities through the soft muscle in the patient's side. By eschewing open posterior surgeries, the surgeons reduce the need for manipulating and damaging the muscles and tendons attached to the spine. "Lateral access allows us to avoid disrupting the posterior muscles," Dr. George explains. "We operate anteriorly, which allows patients to maintain their native structural integrity." To correct the deformity, Drs. George and Vaynman remove the discs and straighten the spine by placing cages in the vacant space. This derotates the spine, bringing it into a more correct position. As neurophysiologists monitor nerve function, surgeons can replace as many as four discs in one procedure, according to Dr. Vaynman. For optimal screw placement, surgeons may use an intraoperative O-arm, which provides X-ray imaging at a quality comparable to that of a CT scan. The system can also be used for navigational purposes during transforaminal lumbar interbody fusion procedures, in which surgeons operate through small incisions. "The O-arm can make a huge differ- ence when dealing with very complex adult deformities," Dr. George explains. "Older patients can have significant spinal rotation that makes implanting hardware and X-ray imaging challeng- ing. We can check the implantation of instr umentation a nd rev iew screw placement with the O-arm before the patient leaves the operating room, and if we find problems with any of the screws, we can remove them at that p o i n t , p r e v e n t i n g t h e n e e d f o r additional surgery." Full recovery can take as long as two yea rs, but during t hat time, ma ny qua lit y-of-life-reducing s y mptoms WHEN YESTERDAY'S GOLD STANDARD FAILS IN THE EARLY 1960s, the first surgical device for straightening and immobilizing the spine from inside the body revolutionized scoliosis repair. The Harrington rod remained the gold standard of scoliosis surgery until the 1980s. Problematically, the system was too successful at straightening the spine. "I have several patients in their 40s who were treated for idiopathic scoliosis 30 years ago with Harrington rods," says Artem Y. Vaynman, MD, FAANS, partner and neuro- surgeon at Neurological Surgery, P.C. "These patients suffer from flatback syndrome, in which the spine loses its natural curvature. Because of this, they've developed spine problems above and below the levels of the spine that were treated when they were adolescents." Revision surgeries are more complicated for a number of reasons. Scar tissue can make surgical approaches more difficult and prolong recovery times, but the failure of the vertebrae to fuse fol- lowing initial intervention means that surgeons have to reconstruct the spine. "You have to break the spine and rebuild it," Dr. Vaynman explains. "This carries higher risks for infection, spinal cord injury and spinal fluid leakage. The challenges of revision surgery reinforce the necessity to carefully approach each initial procedure with a good plan and diligently follow patients after surgery — this is why, in my fellowship, we said, 'You're with the scoliosis patient for life.'" Postoperative X-ray exhibiting spinal instrumentation Dr. George used to correct the deformity of a patient suffering from severe, painful kyphosis Dr. Vaynman uses a spinal model to describe a procedure to a patient in his Rockville Centre office. COV ER FE AT UR E 8 | Long Island MD NEWS ■ M D N E W S . CO M