Allied Devices and Their Influence on Spinal Implants

Nuñez Alvarado L.E. · Handbook of Orthopaedic Trauma Implantology (2023) · DOI: 10.1007/978-981-19-7540-0_101

Resumen

The improvement and evolution of allied devices in spinal surgery have led to improvement of spinal surgery implantology. Intraoperative images with fluoroscopy, navigation based on preoperative computed tomography, cone-beam CT-based navigation, O-arm, and intraoperative tomography provide improved surgical guidance. Navigation systems provide improved accuracy of more than 90% in the placement of pedicle screws. Tubular retraction systems coupled to pedicle screws allow their percutaneous insertion by minimally invasive spine surgery (MISS) techniques. They improve surgical access, allowing the insertion of intervertebral cages securely. Retraction systems offer stable retraction during surgery. The current systems are radiolucent, do not damage the tissue, and allow a minimally invasive approach for the anterior, lateral, and posterior parts of the spine. Intraoperative neurophysiological monitoring (e.g., transcranial motor-evoked potential and evoked electromyography) shows high sensitivity in detecting damage to the motor nerves and is very useful in spinal deformity surgery and in MISS. Laminar flow and high-efficiency particulate air (HEPA) filters have reduced microorganisms in the operating room. Modern surgical tables are versatile and radiolucent and allow the patient to be positioned, reducing the risk of pressure injuries. In addition, the use of microscope, endoscope, and thoracoscope in spinal surgery has improved the precision of surgery. Zoom and digital image enhancement have been crucial for minimally invasive surgery, achieving almost ambulatory spinal surgery. Thus, allied devices have improved the accuracy of implant placement and promoted the development of minimally invasive surgery, in turn allowing the evolution of modern implantology. © Springer Nature Singapore Pte Ltd. 2023.