Resident Icahn School of Medicine at Mount Sinai New York, New York, United States
Introduction: Anterior cervical spine surgery has shown to be safe and effective, with low rates of morbidity and mortality, and favorable patient outcomes. The operating microscope or surgical loupes have been traditionally used for visualization; however, loupes and microscopy have limitations in terms of field of view and working corridor. The exoscope provides high resolution visualization, while allowing the surgeon to operate at a body neutral position. The role of 3D exoscopy in anterior cervical spine procedures is not well understood.
Methods: In a multicenter study at six institutions, 29 MIS spine cases using 3D exoscopy were analyzed. Adult patients were included if they met the following criteria: age 18 years, underwent an anterior cervical spine surgery at a participating institution, and the surgeon used the 3D exoscope for visualization as part of an anterior cervical spine surgical procedure. 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 56.4±12.2 years (range 31-80), mean BMI of 31.6.5±11.1 (range 21-40), with 58.6% female (17 patients). The most common cervical procedures were ACDF (22, 75.9%), corpectomy (4, 13.8%) and cervical disc replacement (3, 10.3%). Six (20.7%) patients had the diagnosis of diabetes, and 7 (24.1%) patients in the cohort reported smoking at the time of surgery. Average operating time was 136.0±61.1 minutes. There were no exoscope collisions found, and only one (3.4%) case converted to the microscope. There were no reported complications in the cohort, and there were no cases where the surgeon reported neck or back strain following conclusion of the procedure.
Conclusion : Visualization technologies have become a vital component of anterior cervical spine procedures. The 3D exoscope is a safe and effective tool for visualizing the surgical corridor for this approach. Future comparison studies assessing the microscope versus the exoscope are warranted to better understand nuances between intraoperative use.