Spinal Navigation & 3-D Imaging at Sky Ridge Medical Center, Denver, Colorado

Those of us who've sat in a movie theater wearing cardboard glasses to view a 3-D motion picture on a big screen would probably all agree it’s a pretty cool technology. And when it comes to 3-D imaging for spinal navigation to assist with delicate, complex spinal surgeries, both physicians and patients likely would agree that this technology makes a pretty nice splash in the operating room, too.

For years now, navigational systems like the Stryker Navigation System at Sky Ridge Medical Center have been assisting surgeons in performing many types of surgeries, such as sinus procedures, joint replacement surgeries and brain surgery. Improving on the fluoroscope, which provides a two- dimensional view during a surgical procedure, the Stryker Navigation System gives doctors a comprehensive, continuous 3-D picture of the precise surgical site in the patient.

Paving the Way with Spinal Navigation

At Sky Ridge, Dr. William Choi is leveraging navigation technology in spinal surgery. In fact, Dr. Choi, Chief of Neurosurgery and Director of the Spinal Navigation Center of Excellence at Sky Ridge, uses this technology in approximately 60% of his surgeries. In fact, Dr. Choi is one of the leading surgeons in the U.S. doing image-guided spine surgery, which he’s been performing for eight years now, and he lectures and teaches nationally and internationally on the procedure. This state-of-the art system allows surgeons like Dr. Choi to perform highly complex surgeries with greater safety, speed and accuracy.

During spinal fusion surgery, for example, most surgeons depend on 2-D images, their understanding of anatomy, and their existing knowledge of the patient to decide where to insert the pedicle screws to fuse two vertebrae in the lumbar spine. Not so when using the Stryker Navigation System. "The navigation system brings 3-D images into the operating room enabling the surgeon to be more precise," says Dr. Choi.

According to Dr. Choi, "the navigation system is used almost universally around the world for brain surgery like complex brain tumor resections. But spinal navigation isn’t as widely used yet. For one thing, there’s a steep learning curve to using the system for spinal procedures, so surgeons have to invest a good deal of time for training. Still, I think that spinal navigation is on the verge of a huge breakthrough."

Dr. Choi notes that Sky Ridge is turning to this highly effective navigation system to assist with some of its more complex spine surgeries, such as spinal tumor resections, herniated disc surgeries and spinal fusions. And whatever the procedure and regardless of how complex, patients themselves can benefit from the insight provided by the navigation system. "Patients can go into their surgeries with a much better picture of what’s going on with their pathology and exactly where the problem lies," says Dr. Choi. Doctors benefit prior to surgery as well. "Surgeons can actually pinpoint where they need to go even before they make the incision," says Dr. Choi.

How the Navigation System Works

The Stryker Navigation System sits near the operating table in the operating room. Prior to surgery, patients undergo a series of CT scans. Once the images are downloaded into the navigation system, surgeons can then perform surgeries based on a true, 3-D anatomical picture of the patient. Surgeons insert a Stryker probing instrument through a small incision in the patient, and then the probe transmits signals back to the system.

The system software integrates the patient’s CT scan with data from the digital camera probe, and then displays a real-time view on-screen of exactly where the instruments are positioned—throughout the procedure. In this way, surgeons can reach the surgical site with greater speed and accuracy, and with less damage to surrounding tissue. This greatly reduces risk to patients.

The system is especially helpful for surgeries proven unsuccessful in the past, since normal anatomical landmarks can be highly irregular due to the former procedures or pathologies. The system can also help surgeons navigate in hard-to-reach areas.

The Sky Ridge Spinal Navigation Center of Excellence

Spinal navigation and other leading-edge technologies are the cornerstones of the new Spinal Navigation Center of Excellence at Sky Ridge. This program aims to bring advances in computer hardware and software technologies, robotics, endoscopic technologies, and other developments into the medical and surgical arena at Sky Ridge and beyond. With the assistance of engineers in various fields, the plan is to further develop these technologies for advanced surgical application. "That’s what the Center of Excellence is all about," says Dr. Choi. "These advances are very important to the patient because they minimize surgical approaches and increase patient safety."

Only a few Denver-area surgeons are performing spinal navigation surgery, all taught by Dr. Choi. But with physicians from around the world inquiring about the advanced spinal navigation procedures being performed at Sky Ridge, the Center of Excellence plans to offer related training in the near future.