ΝΕΕΣ ΧΕΙΡΟΥΡΓΙΚΕΣ ΤΕΧΝΙΚΕΣ (NEW OPERATIVE TECHNIQUES)

1. G.S. Sapkas
1st Orthopaedic Department
University Hospital
“ATTIKON”
Medical School
Athens University

2. Introduction to Image-Guided Surgery
 Since the mid-1970’s,
image-guided surgery
has emerged as an
accepted and clinically
appropriate alternative
to traditional surgery.

3. SSuurrggiiccaall nnaavviiggaattiioonn
hhaass::
 Revolutionized operating room
procedures
 Enhanced pre-operative
planning
 Improved intra-operative
effectiveness and efficiency
 Increased the speed of
post-operative recovery,
and
 Improved clinical outcomes

4.  Modern image-guided surgery has
been described in the clinical
literature using a variety of terms
such as:
 “surgical navigation,”
 “computer assisted surgery,”
 “surgical stimulation,”
 “3-D computer surgery,”
 “surgical navigation”

5. Using surgical
navigation methods,
physicians may make
more accurate
diagnoses
before and during
surgery.

6.  Advanced technologies pr ovide
 computerized, three-dimensional
viewing
 so physicians and surgical teams
can precisely
locate and position
surgical instruments
in the anatomic field
and view the results
on their visual displays

7. As a result,
procedures are
shorter and
protocols are
improved.

8.  Surgical navigation
may also be less invasive
than traditional surgery
as surgeons may be
more accurate
using technologically
advanced devices
in place of (or in addition to)
the traditional hand-guided,
mechanical devices
during surgery.

9.  This allows for
an increased level
of patient safety
and
an overall reduction
in patient morbidity.

10.  In addition,
recent enhancements
to surgical
navigation technology
have enabled
new and more
minimally
invasive procedures
to be possible.

11. Current usage of
Spinal Navigation
and Intra-operative
Imaging

12. Key spine procedures, challenges with
traditional surgery
 Posterior Cervical Fusion
 C1-C2 fusion
 Pedicle screws
 Posterior Thoracic Fusion
(upper thoracic spine)
 Thoracolumbar spine

13.  Spinal trauma
 Minimally invasive
trauma
(screws and rods
percutaneously)

14. Pediatric and adult deformity

15. Posterior Lumbar Fusion
 Degeneration of the
lumbar spine
 Minimally invasive lumbar
fusion
 Revision surgeries

16. IImmaaggee gguuiiddeedd ssppiinnee
ssuurrggeerryy:: ssttaattee ooff tthhee aarrtt
aanndd ffuuttuurree ddiirreeccttiioonnss
Thorsten T. et al, Eur. Spine 2010
Review article

17.  BBaasseedd oonn aa mmeeddlliinnee sseeaarrcchh ttoottaall
ooff 11..446622 ppuubblliiccaattiioonnss ppuubblliisshheedd
uunnttiill OOccttoobbeerr 22000088 wweerree
rreettrriieevveedd
 227766 ppaappeerrss wweerree iinncclluuddeedd iinn tthhee
aannaallyyssiiss
 OOnnllyy ttwwoo RRCCTTss aanndd oonnee
mmeettaa--aannaallyyssiiss hhaavvee bbeeeenn
rreettrriieevveedd

18.  CCoonncceerrnniinngg tthhee mmoosstt
ppooppuullaarr aapppplliiccaattiioonn ooff
iimmaaggee gguuiiddeedd aapppprrooaacchheess
ppeeddiiccllee ssccrreeww iinnsseerrttiioonn,,
tthhee eevviiddeennccee ooff cclliinniiccaall
bbeenneeffiitt iinn tthhee mmoosstt
ccrriittiiccaall aarreeaass ee..gg tthhee
tthhoorraacciicc ssppiinnee iiss ssttiillll
llaacckkiinngg

19.  IInn mmaannyy ootthheerr aarreeaass
ooff ssppiinnee ssuurrggeerryy ee..gg..
vveennttrraall ssppiinnee ssuurrggeerryy
oorr ttuummoorr ssuurrggeerryy,,
iimmaaggee gguuiiddeedd
aapppprrooaacchheess aarree ssttiillll
iinn eexxppeerriimmeennttaall
ssttaaggeess

20.  TThhee tteecchhnniiccaall
ddeevveellooppmmeenntt ooff iimmaaggee
gguuiiddeedd tteecchhnniiqquueess hhaass
rreeaacchheedd aa hhiigghh lleevveell aass
tthhee aaccccuurraacciieess tthhaatt ccaann
bbee aacchhiieevveedd tteecchhnniiccaallllyy
mmeeeett tthhee aannaattoommiiccaall
ddeemmaannddss

21. HHoowweevveerr tthheerree iiss
eevviiddeennccee tthhaatt tthhee
iinntteerraaccttiioonn bbeettwweeeenn
tthhee ssuurrggeeoonn
((hhuummaann ffaaccttoorr))
aanndd tthhee nnaavviiggaattiioonn
ssyysstteemm iiss aa ssoouurrccee ooff
iinnaaccccuurraaccyy

22. ““AATTTTIIKKOONN”” UUNNIIVVEERRSSIITTYY HHOOPPSSIITTAALL