Intra-operative Difficulties: Mitigation Strategies
There are some common themes of intra-operative problems in spinal deformity surgery that can occur span surgeon seniority. Situations where the pedicle screws are difficult to insert or have resulted in an iatrogenic complication require alternative anchors options. An understanding of these with their relative merits and de-merits would help in a crisis. Some curves are very stiff. Surgical maneuvers can create flexibility of the apical segments. The indications, contra-indications of such techniques would be discussed. Surgery can be made safer with a good interaction with the other healthcare personnel in the operating room. These include the anesthetists’ team, spinal cord technicians. An appreciation of the relative roles and the checklists can help in a situation of excessive blood loss, loss of signals or a systemic complication. Ensuring safe surgical practices and the consideration of staging the operation should be explored. We will discuss some of the newer surgical developments such as navigation, robotic surgery, and cross sectional intra-operative monitoring.
Spine surgeons (orthopaedic and neurological surgeons), residents, fellows, nurses, nurse practitioners, physician assistants
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