Machine Vision Navigation in Spine Surgery

The advancements in computing and digital localizer technologies has led to the evolving clinical application of image-guided technology for the surgical management of spinal disorders. Image-guided spinal navigation addresses the limitations of fluoroscopy and improves the accurate placement of fixation screws. Several navigation platforms are currently available, each having its own unique advantages and disadvantages. The most recent spinal navigation system developed utilizes machine vision structured light imaging which creates a precise and detailed three-dimensional image of the exposed surface anatomy and co-registers it to a pre-operatively or intra-operatively acquired image. This system improves upon the intraoperative workflow and efficiency of the navigation process. With the continued advancements in machine vision, there is a potential for clinical applications that extend beyond surgical navigation. These applications include reducing the potential for wrong level spine surgery and providing for real-time tracking of spinal deformity correction. As the adoption and clinical experience with navigation continues to expand and evolve, the technology that enables navigation also continues to evolve.

Incidence of Neurosurgical Wrong-Site Surgery Before and After Implementation of the Universal Protocol

BACKGROUND: Although exceedingly rare, wrong-site surgery (WSS) remains a persistent problem in the United States. The incidence is thought to be 2 to 3 per 10 000 craniotomies and about 6 to 14 per 10 000 spine surgeries. In July 2004, the Joint Commission mandated the Universal Protocol (UP) for all accredited hospitals. OBJECTIVE: To assess the effect of UP implementation on the incidence of neurosurgical WSS at the University of Illinois College of Medicine at Peoria/Illinois Neurological Institute. METHODS: The Morbidity and Mortality Database in the Department of Neurosurgery was reviewed to identify all recorded cases of WSS since 1999. This was compared with the total operative load (excluding endovascular procedures) of all attending neurosurgeons to determine the incidence of overall WSS. A comparison was then made between the incidences before and after UP implementation. RESULTS: Fifteen WSS events were found with an overall incidence of 0.07% and Poisson 95% confidence interval of 8.4 to 25. All but one of these were wrong-level spine surgeries (14/15). There was only 1 recorded case of wrong-side surgery and this occurred after implementation of the UP. A statistically greater number of WSS events occurred before (n = 12) in comparison with after (n = 3) UP implementation (P < .001). CONCLUSION: A statistically significant reduction in overall WSS was seen after implementation of the UP. This reduction can be attributed to less frequent wrong-level spine surgery. There was no case of wrong procedure or patient surgery and the 1 case of wrong-side surgery occurred after UP implementation.