Tag: Planning

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The gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery

J Neurosurg Spine 42:309–319, 2025

This study assessed surgeons’ ability to achieve preoperative sagittal alignment goals in adult cervical spine deformity surgeries. Results showed significant deviations from targets, especially in severe deformities, highlighting the need for improved surgical planning and personalized implants.

Study Overview

• Objective: Assess surgeons’ ability to achieve preoperative sagittal alignment goals in CSD surgery.

• Methods: Prospective study with adult CSD patients across 13 North American centers.

• Patient Demographics: Mean age 63.6 years; 51.1% women; 38.6% had previous cervical fusion.

Key Findings

• Alignment Goals: Surgeons failed to meet goals by 17.2 mm for C2–7 SVA, 10.3° for Cobb angle.

• Factors Affecting Outcomes: Greater baseline TK linked to better Cobb angle achievement.

• Surgical Planning: 60% used PACS, 33.3% used spine-specific software.

• Tools and Criteria: Ames/ISSG criteria used by 33.3% of surgeons; others individualized goals.

Challenges and Recommendations

• Severe Deformities: More challenging to achieve alignment goals in severe cases.

• Need for Advancements: Personalized implants could improve intraoperative goal achievement.

• Alignment Correlations: Strong correlation for C7–S1 SVA, weak for C2–7 SVA.

Statistical Analysis

• Offset Groups: Patients categorized by offset magnitude from goal alignment.

• Significant Associations: Lower baseline TS-CL associated with better TS-CL goal achievement.

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Optimizing Surgical Efficiency in Complex Spine Surgery Using Virtual Reality as a Communication Technology to Promote a Shared Mental Model

Operative Neurosurgery 26:213–221, 2024

Virtual reality (VR) is an emerging technology that can be used to promote a shared mental model among a surgical team. We present a case series demonstrating the use of 3-dimensional (3D) VR models to visually communicate procedural steps to a surgical team to promote a common operating objective. We also review the literature on existing uses of VR for preoperative communication and planning in spine surgery.

METHODS: Narrations of 3 to 4-minute walkthroughs were created in a VR visualization platform, converted, and distributed to team members through text and email the night before surgical intervention. A VR huddle was held immediately before the intervention to refine surgical goals. After the intervention, the participating team members’ perceptions on the value of the tool were assessed using a survey that used a 5-point Likert scale. MEDLINE, Google Scholar, and Dimensions AI databases were queried from July 2010 to October 2022 to examine existing literature on preoperative VR use to plan spine surgery.

RESULTS: Three illustrative cases are presented with accompanying video. Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models. Respondents felt that preoperative VR video review was “moderately useful” or more useful in improving their understanding of the operational sequence (71%, 5/7), in enhancing their ability to understand their role (86%, 6/7), and in improving the safety or efficiency of the case (86%, 6/7).

CONCLUSION: We present a proof of concept of a novel preoperative communication tool used to create a shared mental model of a common operating objective for surgical team members using narrated 3D VR models. Initial survey results demonstrate positive feedback among respondents. There is a paucity of literature investigating VR technology as a means for preoperative surgical communication in spine surgery.

ETHICS: Institutional review board approval (IRB-300009785) was obtained before this study.

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