In this issue

October 2017

A GPS Finds Its Way to the Spine

Today the most ubiquitous consumer technologies are making their way to the operating room to treat conditions of the spine. One important example of this technology is image guided surgery – also referred to as surgical navigation.

Similar to a car or mobile Global Positioning System (GPS), surgical navigation gives the surgeon a three-dimensional view of the critical structures of a patient’s spinal column and allows him to construct a spinal “map” to guide him during a procedure. A camera captures the anatomy of the spinal column, along with the surgeon’s precise movements, and both are displayed on a large monitor and viewed by the surgical team. The team is fully engaged, which facilitates greater collaboration, and saves crucial time during surgery.

From a Two-Dimensional World…

One of challenges of spine surgery is being able to see the entire spinal column, unlike viewing a single organ. In the spinal column, the spinal cord and nerves as well as other critical structures are shielded from view and difficult to visualize and navigate, especially for procedures to stabilize the spine that require hardware, such as screws and cages to hold a lumbar implant in place.

Also surgeons are limited to working with multiple x-rays, which are only two-dimensional, in trying to reconstruct complex three-dimensional anatomy. Complication rates are higher, procedures last four to six hours and often require seven days or more in the hospital. With navigation, surgeons can achieve the same results for patients in 90 minutes with one to two days in post-op recovery in the hospital.

To a Three Dimensional World…

Image navigation, and the ability to construct a three-dimensional model and be guided during the procedure, has dramatically changed spinal surgery. For example, three-dimensional visualization makes it possible to insert a lumbar implant within a space that could be as small and narrow as a 5-millimeter channel, where sub-millimeter accuracy of the implant is essential. It allows surgeons to see where they are going.

Patients with deformities, such as scoliosis, or traumatic conditions such as fractures, and degenerative conditions such as disc disease and spinal stenosis can all benefit from surgical navigation. Procedures are shorter, recovery is faster and pain is diminished for patients.

Pacific Brain & Spine neurosurgeons have been using navigation technology since 2008. The East Bay neurosurgical practice is also second in the country to use O-arm 2, the latest navigation system from Medtronic, which was released in 2016. And Dr. Mimran is a leading educator in the field of navigated spine surgery and has taught over 200 courses worldwide.

One 50-year-old patient, an executive at a large company in Silicon Valley, injured his back while packing up his house to move to the Bay Area. He had excruciating back pain with sciatic pain down the back of his leg which made him unable to move that leg and left him wheel chair bound. Using image-guided navigation, Dr. Mimran performed minimally invasive lumbar surgery and the patient was discharged 24 hours later, with greatly diminished pain or need for a wheelchair. He was back to work within three weeks.

“We are just scratching the surface of what we can do in spine surgery,” Dr. Mimran said. “Deformity correction, surgical planning and execution, minimally invasive solutions to complex problems are now possible through navigation.”

Dr. Mimran Named “Top Doctor for 2017

Ronnie I. Mimran, MD, of Danville, Calif.-based Pacific Brain & Spine, earned recognition as a 2017 Top Doctor in the San Francisco Bay Area. > Read more

New Patient Checklist

On the administrative side, our office strives to provide exceptional care for our patients from the moment they walk in to our office. Gathering information before their first appointment is key to a comprehensive consultation. For your convenience we have included a checklist along with our contact information that you can hand to your patients before they schedule an appointment.

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