April 28, 2022

Spine Safety in the Operating Room

Dr. Venu Vemuri

There is a wide misconception about the safety of spine surgery. Some of my patients assume it’s dangerous and should be avoided at all costs. Will I be paralyzed? they ask. For April Spine Safety month, I wish to highlight all the precautions we take at miiSpine to keep you safe in surgery.

Have you heard of the surgery checklist? Atul Gawande, a Harvard surgeon popularized this concept modeled after the airline industry. Before the knife is lifted, I check off a list of over 100 items like a pilot before takeoff.  Surgery is like a symphony with many parts and players. Being a surgeon is like being the conductor of this symphony. Without my team including nurses, techs, vendors, and surgical assistants, there would be no operation. Like a conductor, I spend time studying the anatomy and imaging much like a maestro studies the orchestral score. I coordinate vendors to bring in the necessary equipment to ensure we are prepared for all possible events. I visualize the steps of every operation in my mind before the first cut. Once surgery begins, everyone knows their part and our preparation assures the best possible outcome for the patient. When something unexpected happens, we know the script and follow the checklist to get back on track.

Can I be paralyzed? This is naturally a thought that goes through the minds of patients undergoing spine surgery. Many spine surgeries involve the Lumbar spine. Many are not aware that the spinal cord usually ends above or at the very top of the lumbar spine. Therefore, any nerve injury in the lumbar spine will not cause paralysis of a whole leg or arm. It is possible but still rare to have a nerve root be injured causing weakness in the muscle it powers. This is often reversible with natural nerve recovery. An example is foot drop from injury to the L4/L5 nerve.

To prevent any nerve injury, we use advanced Neuro monitoring in the OR. A technician with special training places needles in key muscles and the scalp to test your nervous system during surgery. A neurologist monitors the readings off site and warns the technician of any abnormalities. We can test the location of screws placed near nerves to make sure they are safe. I am especially exited to use a new system called Safe-Ops. This new technology is more sensitive for detecting nerve irritation during surgery. When alerted early, we can for example move a retractor to improve the signal and save the nerve!

Radiation is used before, during, and after all spine surgeries. The cumulative effect can be harmful and even cause cancer. At miiSpine, we take this risk very seriously. That’s why we use the revolutionary EOSedge. This machine takes full body images with up to 80% less radiation. It was developed to reduce the 2X risk of breast cancer in females with scoliosis due to repeated X-rays taken to monitor curve progression.  miiSpine has one of only two of these machines in Louisville!

Infections are one of the feared complications in any surgery. Lumbar spine fusions carry a 4 to 6% chance of infection. If the infection spreads to the blood, the result could be life threatening. At miiSpine, we take infection prevention very seriously. By practicing minimally invasive spine surgery, our infection rates are significantly lower than traditional spine surgery. In fact, Dr. V has a .002% infection rate for his surgeries at Metro Specialty Surgery Center, where he does only minimally invasive spine surgery. Minimally invasive spine surgery carries a lower infection rate because there is less disruption to normal anatomy and smaller windows into the body create less dead space for bacteria to grow.

Safety first. At miiSpine we strive for the best outcomes possible. Treating the spine is a huge responsibility we take very seriously. Patients are trusting us with one of the bodies most vital structures. Our protocols and systems are designed to keep you safe.

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