GPS for the Operating Room

I have gotten to the point at which I won't buy a car unless it has a navigation system installed. I am not sure if it is laziness, or an attraction to technology, or simply that I am tired of learning and remembering directions. Whatever it is, I consider the GPS system absolutely essential; to me, it is on the same level as airbags, anti-lock brakes, power steering and at least 6 cupholders.

The same type of navigation technology has been used in neurosurgery for years. We have been using equipment that enables neurosurgeons to triangulate coordinates within patients' brains in much the same way that the satellite system orbiting the earth is able to triangulate coordinates on the surface of the planet. The equipment is so precise that we have been able to achieve sub-millimeter accuracy- this translates to being able to safely and accurately guide our instruments to the region of interest (i.e., a brain tumor) with smaller incisions, and with less damage to the surrounding regions. When you are talking about a 5-millimeter tumor that is 60-millimeters below the surface, it means a tremendous amount that we know exactly where we are going.

Neurosurgeons and their patients have been enjoying the benefits of these navigation systems for years. But there is a catch...


They were terrible when it came to spine surgery.


Inaccurate. Cumbersome. Time-consuming. I tried them several times for complex spinal operations when I was in Florida, and each time that I can remember, I abandoned the use during the case because my own "internal GPS" disagreed with the system and I didn't think it was safe for the patient to continue to use it at the time. I figured, when the time was right, the technology would improve to the point that it would become useful for spinal operations.

Well, the time is now right. When I came to the Bay Area in 2005, I was tasked with helping to build a spine center of excellence in the East Bay. The first piece of equipment that I identified as an essential piece of the puzzle was the "O-arm", a first-of-its-kind device that, for the first time, merged the the cranial navigation technologies with the complexities inherent in the spine.

You can think of it as an intra-operative CT scanner for spine surgeons. In a "real-time" fashion, we can capture 3-dimensional images of the patients spine, showing us unparalleled anatomical details, and use those images with intra-operative navigation. Think of it as the GPS system in your car, except that the system is constantly taking new pictures of the roads from space, allowing you to instantly change direction if needed.

The O-arm is remarkably accurate, and can be used in a variety of different spinal operations. Eden Medical Center purchased one in 2009, and we have been using it for almost 6 months now. Many of the complex degenerative and deformity cases have been dramatically simplified with its use, but its true utility shines in traumatic cases. Spine injuries from falls, accidents, assaults (and a ton of mechanisms that I can't think of right now!) are amongst the toughest to treat. The fractures and soft tissue injuries can be extensive and unpredictable and oftentimes, difficult to characterize for the surgeon. The O-arm allows us to visualize these complex injuries, navigate them with precision, and repair and reconstruct the patients normal anatomy.

I think my patients benefit from the O-arm to degrees that many of them will never know. I don't need it for every spine surgery, but I am definitely grateful to have it when I do need it.

Come to think of it, the GPS in the car is much the same; I don't need it for every drive, but I am definitely grateful that it is there in some neighborhoods...