Use of 3D Exoscopy in Intradural Spinal Detethering Surgery: A Multicenter Study

Introduction: Intradural spine surgery for detethering of neural elements is a proven safe and effective procedure to improve patient pain and disability. Convention visualization during these procedures is performed with the microscope, however, this is limited by a narrow field of view and working distance. The exoscope allows surgeons and observers to view the field in improved 3D visualization, while maintaining a neutral neck and back position. The role of the exoscope in intradural detethering procedures has not been well studied.

Methods: In a multicenter study at six institutions, 19 lumbar intradural procedures were performed using the 3D exoscope. Adult patients were included if they received an intradural detethering procedures with the exoscope at a participating institution. Patients were excluded if the surgeon did not use the exoscope for visualization, or the approach was not determined to be “MIS” according to the surgeon, or if the surgeon failed to complete a survey regarding the case details following conclusion of the case.

Results: Demographic analysis showed a mean age of 41.1±17.5 years (range 18-82), mean BMI of 27.2.5±6.0 (range 17-38), with 89.5% female (17 patients). No patients had the diagnosis of diabetes, and 3 (15.8%) patients in the cohort reported smoking at the time of surgery. Five (26.3%) patients reported prior spine procedures, but none had prior detethering procedures. Average time under the exoscope ranged from 17-47 minutes (mean 25.5). There were no exoscope collisions, and no cases converted to the microscope. There were no cases where the surgeon reported neck or back strain following conclusion of the procedure.

Conclusion : The 3D exoscope is a safe and effective tool for visualizing intradural lumbar pathology in detethering procedures. Future comparison studies are needed to compare the microscope and exoscope in this context.