Walid Ismail Attia
Director, Spine Fellowship Program Departments of Neurosurgery/Spine Surgery National Neuroscience Institute, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia.
Title: Managing Hardware to revise complex spine cases; would the O-Arm and Neuronavigation be a magic wand in the hands of the surgeon or just a burden?
Biography:
Dr Walid Ismail El Shahat Aly Attia has received his PhD in Neurosurgery from Shinshu University School of Medicine during the period of 2003. Currently, he is working as Consultant in Departments of Neurosurgery/ Spine Surgery in National Neuroscience Institute, King Fahad Medical City. He has successfully completed his Administrative responsibilities. His research has included Microvascular pathology, cervical kyphotic deformity, Minimally invasive surgery. Based on this research and fellowship training he has received several awards and honors, such as: Recipient of the Outstanding Graduation award (top 30 graduates) in the Republic High School Diploma examination, the Egyptian Ministry of Education. 1986 and Recipient of the Outstanding Graduation award and Honors, Tanta University Faculty of Medicine (4th on class of 320 graduates) 1992. He is serving as an editorial member of several reputed journals like Journal of Medicine and Medical Science, Journal of Psychiatry and Neuroscience, Journal of Clinical and Experimental and many more. He has authored approximately 8-9 research articles and 7 books.
Abstract:
Purpose: The type and extent of surgeries carried out for complex spine disorders still lacks evidence-based medicine proof. It is up to the health care providers sound judgement and expertise to do what is needed for the patient. This is even worse for revision spine surgeons. Surgical challenges include yet not limited to; removal of misplaced or displaced hardware near vital structures, decompression near vital vascular or neural structures, decompression at a blind angle, and difficult trajectories for instrumentation and re-instrumentation. The use of intraoperative CT-quality O-arm, and neuronavigation are still tested as aiding tools in such operative modalities.
Methods: We randomly selected 10 cases of complex spine modalities that were operated upon in the years 2013- 2018 in our institute by the author to be included in this retrospective study. Cases include traumatic spinal fractures, infective, inflammatory, benign and malignant neoplasms affecting different parts of the spinal column. All of them had technical challenges regards misplaced hardware and re-instrumentation. All had undergone a combination of decompression and instrumentation of different modalities and/or bone grafting. In all cases the Medtronic O-arm and Medtronic StealthStation were used as intraoperative mapping tools.
Results: Intraoperative navigation tools were so useful in securing safe hardware removal, adequate neural decompression, neural and vascular tissue safety together with tough bony purchases of the hardware from the first and only trial of application. Intraoperative CT taken by the o-arm was a useful confirmatory intraoperative test for final proper hardware placement. A group of technical problems have been faced. All are studied in some details.
Conclusion: The intraoperative use of the O-arm and stealthStation is very useful in different modalities of revision complex spine surgeries. Some technical problems were addressed and studied. A learning curve is mandatory to feel comfortable with that technology.