Current and future advances in spinal surgery

Abstract

This article presents the medical and social problems in spine surgery for the next 5‒10 years in Japan. The following 3 issues are discussed, 1）minimal invasive spine surgery（MISS）for elderly patients, 2）intraoperative monitoring for surgical safety, and 3）virtual reality simulation for presurgical planning and operative education. 1）MISS in the elderly MISS was developed to treat spine diseases while avoiding significant damage to the muscles surrounding the spine. This results in less pain after surgery and a faster recovery, which is especially helpful for elderly patients. Minimally invasive procedures can shorten hospital stays. The exact length of time needed in hospital will vary. However, in general, after MISS patients go home on the same day or within 1 to 2 days. Due to our increasingly aging society, less invasive techniques will become increasingly important. 2）Intraoperative monitoring for surgical safety Intraoperative monitoring of motor evoked potentials（MEPs）and somatosensory evoked potentials （SSEPs）has been recently investigated as a means of preventing motor deficits associated with spinal operations. The combination of these techniques is known as concomitant multimodal intraoperative monitoring and could be a helpful tool in spinal surgery since it is associated with a high specificity and sensitivity for detecting intraoperative neural damage. Also, post‒tetanic MEPs（p‒MEPs）can be used to improve the reliability of monitoring motor function during spinal surgery, especially in complicated cases. 3）Virtual reality（VR）simulation for educating young surgeons Advances in computing have enabled continued growth in VR, visualization, and simulation technologies. VR‒based simulators are becoming common in some surgical subspecialties, and 3‒dimensional（3D） imaging data can be used to further understand complex anatomical relationships in specific patients. From our recent experience, VR simulations of spinal surgery and neurosurgery were quite useful for understanding the complicated spatial relations of anatomical landmarks and in examining surgical approaches. Planning with interactive computer graphics helps to improve the surgical effect, which in turn decreases morbidity. Additionally, VR could be used for educating young spinal surgeons.