Resident Icahn School of Medicine at Mount Sinai New York, New York, United States
Introduction: Minimally invasive (MIS) approaches to the spine have shown to have comparable outcomes to open approaches, and are associated with lower rates of morbidity and mortality, and faster patient recovery. The exoscope provides superior 3D visualization resolution at a greater working distance, allowing surgeons to operate at a body neutral position. The utility of the 3D exoscopy in MIS spine surgery has not been well established.
Methods: In a multicenter study at six institutions, 109 MIS spine cases using 3D exoscopy were analyzed. Adult patients were included who underwent a spine surgery at a participating institution. Patients were excluded if the surgeon did not use the exoscope for visualization, 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 54.9±16.6 years (range 18-90), with 61.5% female (67 patients). 40 (36.7%) patients received cervical procedures, and 69 (63.3%) received lumbar procedures. The most common lumbar procedures performed with the exoscope were laminectomy/foraminotomy (34.8%), spinal cord detethering (27.5%), microdiscectomy (24.6%). Fourteen (12.8%) patients had the diagnosis of diabetes, and 26 (23.9%) patients in the cohort reported smoking at the time of surgery. Two (1.8%) cases converted to the microscope. Two durotomies (1.8%) were reported in the series, otherwise no intraoperative complications were found. There were no cases where the surgeon reported neck or back strain following the procedure.
Conclusion : Minimally invasive approaches to the spine have become increasingly prevalent in today’s spine practice. The exoscope is safe and effective as a visualization device in the context of MIS spine. Further comparison assessing outcomes between the operating microscope and 3D exoscope are warranted.
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