OR 11 is equipped with a portable intraoperative CT machine, a yellow ring-like x-ray machine, which is used to scan the work in progress and update the navigation system. Right now, the running spine surgery is co-conducted by senior surgeon Julia Onken. On the screen of the navigation tool, the patient is tracked in real time and the angle of the drill can be aligned at a tenth of a degree. A whole rack of titanium screws has been rolled into the OR by a surgical technician dedicated to these costly accessories. The senior surgeon is catching up with her chief, speaking fast with a muffled voice while their hands are engaged in a complex choreography. He interrupts her, however, as an unexpected difficulty comes up: the bolt is not fitting well on the screw, deep down into the bone. There is a moment of struggle to get this one right. Suddenly, a great deal of strength must be applied to bring the head of the long steel key in perfect alignment with the axis, which is adapted to the desired position of the vertebral column. The room is quiet for a moment as the chief battles and rails. The fixateur is then scanned for position control, things are looking good. The stream of words starts to flow again in the room.
Intraoperative imaging is one of several now well-established application areas of image guidance in surgery. The basic principle behind it means that the surgeon acts in real time upon visual information on otherwise hidden or invisible structures which can help optimize screw placement, identify borders of a tumor or hit a delicate target (as in deep brain stimulation).
Anna L. Roethe:
Miner, Robert C. “Image-Guided Neurosurgery.” Journal of Medical Imaging and Radiation Sciences 48, no. 4 (December 2017): 328–35.
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