In this video, Ghost demonstrates how you can learn the process of spinal fusion in under 10 minutes with the aid of VR surgical simulations. Custom made by Ghost Medical, “Ghost VRSE II”, is the VR surgery sim that guides our host Nicolas Widerhold and special guest, plastic surgeon, Dr. Richard J Brown through various steps in implementing Spineology's Optimesh for Spinal Fusion.
Note: the steps for spinal fusion shown are an example specifically for implementing Spineology’s Optimesh in a minimally invasive manner. It is important to recognize that there are various Spinal Fusion methods.
In this VR Surgery, it is already implied that the patient’s preoperative evaluation is determined, they are already sedated from anesthesia and ready for surgery.
A small incision is made in the skin over the area of the spine that requires fusion. Minimally invasive techniques aim to minimize tissue damage and scarring. The surgeon makes a small incision, usually less than an inch long, near the affected spinal segment.
A guide pin is a thin, pointed instrument used to help guide the placement of the dilator during the creation of the access portal. The surgeon starts by making a small skin incision at the targeted entry point, usually using a scalpel (discussed below). After the incision, the guide pin is carefully inserted through the incision and gently advanced towards the target disk space. The guide pin is used in conjunction with fluoroscopic guidance to ensure accurate placement and alignment with the desired surgical path. The surgeon may adjust the trajectory and depth of the guide pin as needed to ensure optimal positioning for subsequent steps.
A scalpel is a surgical instrument with a sharp, narrow blade used for making precise incisions in the skin and subcutaneous tissue. Once the guide pin is correctly positioned, the surgeon uses a scalpel to create a small incision at the entry point. The size of the incision can vary but is typically kept as small as possible, usually less than an inch in length, to minimize tissue trauma and scarring.
Using fluoroscopic guidance or other imaging techniques, the surgeon identifies the precise location of the affected spinal segment. A dilator is inserted through the incision and carefully advanced towards the target disk space. The retractor gently separates and retracts the surrounding muscle and tissue to create a working corridor. As the retractor is gradually advanced, it allows the surgeon to reach the targeted disk space while minimizing damage to surrounding structures.Throughout this process, fluoroscopy or imaging is used to ensure accurate positioning of the retractor and to verify the correct placement before proceeding to the next steps.
A neuro probe is a specialized instrument with a thin, tapered tip that is used to gently and precisely navigate through the soft tissues, muscles, and ligaments to reach the target area. The neuro probe is inserted through the initial incision and carefully advanced towards the spinal segment that requires treatment. It helps create a controlled pathway by gradually separating and retracting the surrounding tissues without causing significant trauma.
A dilator is a tubular instrument with a tapered or conical shape that is inserted into the access portal after using the neuro probe. The dilator is gently advanced along the pathway created by the neuro probe, gradually expanding the access portal. By gradually increasing the size of the access portal, the dilator allows for a wider working space while minimizing damage to surrounding tissues.
The impactor and mallet are used to further create a sufficient opening in the bone, allowing access to the disk space. The impactor, a specialized instrument with a flat or rounded end, is inserted through the access portal. The surgeon carefully positions the impactor on the bone surface adjacent to the disk space and then strikes the impactor with a mallet. The impactor, when struck, delivers controlled force to gently and precisely create a cavity or space in the bone, expanding the access portal.
After the initial bone preparation using the impactor, a dilator is reintroduced into the access portal. The dilator is carefully guided through the expanded opening in the bone, gradually widening the pathway towards the disk space. The surgeon may use a series of progressively larger dilators to ensure adequate space for subsequent steps.
The access portal refers to the pathway that has been created through the soft tissues, muscle layers, and bone to reach the target disk space. It serves as the entry point for the surgical instruments and devices that will be used to perform the discectomy and disk replacement.
Once the access portal is established, the surgeon proceeds with the discectomy, which involves removing the damaged or herniated disk material. The surgeon carefully removes the portion of the disk that is causing the compression or impinging on nearby nerves or spinal structures. This technique involves the use of a microscope or surgical loupe, allowing the surgeon to visualize the surgical area in detail. Small instruments, such as a microsurgical scalpel or forceps, are used to remove the damaged portion of the disk. Throughout the discectomy process, surgeons use imaging techniques, such as fluoroscopies to verify the progress and ensure that the appropriate amount of disk material is removed.
The drill is a powered instrument used to remove bone or create holes in bone structures. In the discectomy step, the drill is used to create an opening or enlarge the access portal in the bone surrounding the affected disk space.
A shaper is a specialized tool used to smooth or reshape the bony surfaces after the initial bone removal. After using the drill, the shaper can be employed to refine the bone edges surrounding the disk space. It ensures a clean and smooth surface, minimizing the risk of any remaining rough edges that could potentially irritate surrounding tissues.
An articulating curette is a small, spoon-shaped instrument with a flexible shaft that allows for controlled manipulation within the disk space. During the discectomy, the articulating curette is used to remove the damaged or herniated disk material.The flexible shaft enables the surgeon to navigate around anatomical structures and reach the affected area within the disk space, ensuring thorough removal of the problematic disk material.
A rongeur is a surgical instrument with a sharp, scissor-like tip used to remove small pieces of bone or soft tissue. In the discectomy step, a rongeur may be used to remove any remaining bone fragments, bony spurs, or protrusions that were not adequately addressed by the drill or shaper. The rongeur allows for precise bone removal, creating additional space and improving visualization of the surgical field.
Suction is a tool used to remove fluid, debris, or blood from the surgical site. During the discectomy, suction is employed to maintain a clear surgical field by removing fluid or debris generated during the procedure. It ensures optimal visibility for the surgeon, enabling precise and controlled removal of the damaged disk material.
A tissue extractor brush is a small instrument with bristles or a soft brush-like tip. It is used to gently clean and remove any remaining tissue or debris from the disk space after the main discectomy has been performed. The brush can be maneuvered within the disk space to ensure thorough cleaning before proceeding to subsequent steps of the procedure.
The reverse articulating curette is a specialized instrument with a reversed curvature similar to the articulating curette. It can be used during the discectomy step to access and remove tissue or debris from hard-to-reach areas within the disk space. The reverse articulating curette allows the surgeon to navigate around anatomical structures and effectively address challenging areas with limited visibility.
A deflated balloon catheter is inserted through the access portal and into the disc space. A contrast dye is injected through the catheter into the intervertebral disc. The contrast dye helps outline the disc's structure and identify any abnormalities or tears within the disc. After the contrast dye is injected, fluoroscopic images are taken. These images capture the flow of contrast within the disc, providing detailed information about the disc's condition and any potential leaks or disruptions in the disc structure. The images obtained from the fluoroscopy are carefully reviewed and analyzed by the surgeon or a radiologist. They assess the integrity of the disc and identify areas of abnormal contrast distribution.
A balloon catheter is a medical device consisting of a thin, flexible tube with an inflatable balloon at its tip. A deflated balloon catheter is carefully placed through a small access portal and into the space of the intervertebral disc under guidance. Once the balloon catheter is properly positioned, a contrast dye is injected through the catheter and into the intervertebral disc. The injected contrast dye serves the purpose of outlining the structure of the disc.
Spineology's Optimesh, a specialized implant, is placed between the prepared surfaces of the vertebrae. Optimesh is designed to provide stability and promote bone growth between the vertebrae, facilitating fusion.
The Optimesh Inserter is a specialized instrument designed for the insertion of the Optimesh implant. The Optimesh implant is a synthetic mesh device used to replace the damaged or removed intervertebral disk. The inserter is used to accurately and precisely position the Optimesh implant into the empty disk space. It allows for controlled delivery of the implant, ensuring proper placement and alignment within the spinal column.
The Diverter Tube is a component that is utilized in conjunction with the Optimesh Inserter. It acts as a guide or conduit through which the Optimesh implant is delivered into the disk space. The Diverter Tube assists in maintaining the shape and structure of the Optimesh implant during insertion, preventing deformation or damage.
The Rod and Mallet are tools used for the placement and fixation of the Optimesh implant. The Rod is a slender, cylindrical instrument that is inserted into the Diverter Tube to push the Optimesh implant into position within the disk space. The Mallet is a specialized hammer-like instrument used to gently tap or impact the Rod, facilitating the controlled insertion of the Optimesh implant. The Rod and Mallet combination allows for precise implant placement and proper alignment within the spinal column.
The Release Driver is a tool used to detach or release the Optimesh implant from the Optimesh Inserter. Once the Optimesh implant is properly positioned within the disk space, the Release Driver is employed to disconnect the implant from the inserter. This step ensures that the Optimesh implant remains securely in place while the inserter is removed from the surgical site.
Note: the rest of the steps for Spinal Fusion Surgery are not included in this particular VR Simulation but are advised and assumed for real surgeries
The incisions are carefully closed using sutures or staples. The surgeon may also use tissue glue or adhesive strips to aid in the healing process.
The patient is monitored in a recovery area and then moved to a hospital room. Pain management, physical therapy, and instructions for postoperative care, including restrictions on activities and the use of assistive devices, may be provided. The patient's progress is closely monitored to ensure proper healing.
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