Description

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.

Target Audience:

Spine surgeons (orthopaedic and neurological surgeons), residents, fellows, nurses, nurse practitioners, physician assistants

Learning Objectives:

1. Recognize the intra-operative technical surgical difficulties with regards difficult anchors and the ability to correct a very stiff curve.
2. Recognize and mitigate problems arising from intra-operative neuro-monitoring changes that warrant a pro-active involvement, algorithmic approach and maintain a good verbal and non-verbal communication with the team.
3. Being cognizant of the problems that can lead to a systemically unstable patient where a ‘step back’ approach would be mandated to support the anesthesiologists’ team, and utilizing effective blood conservation strategies.
4. Identifying and discussing new technologies such as robotics.