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Ma A, Xie N, Reidy J, Mobbs RJ. Three-dimensional endoscopy in lumbar spine surgery as a novel approach for degenerative pathologies: a case report. J Surg Case Rep 2024; 2024:rjae540. [PMID: 39211372 PMCID: PMC11358044 DOI: 10.1093/jscr/rjae540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Endoscopic spine surgery has evolved exponentially. However, the two-dimensional (2D) view results in lack of stereoscopic vision and depth perception, contributing to the steep learning curve. This case report recounts a world first trial of a three-dimensional (3D) endoscopic system that converts 2D to 3D images and explores its potential role in the surgical management of degenerative lumbar spine diseases. The 3D endoscopic system was used for two patient cases and both 2D and 3D images were displayed side by side and compared. Advantages of the 3D endoscopic system include increased perception of depth, rapid identification of bleeding points, and greater visualization of anatomical details. Field of view and exposure were identical in 2D and 3D views. Limitations include costs and need for additional equipment. Overall, 3D endoscopy improved depth perception, instrument manoeuvrability, and recognition of anatomical details. This case report can guide further research and training in endoscopic spine surgery.
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Affiliation(s)
- Alison Ma
- Faculty of Medicine, University of New South Wales, Sydney 2052, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
| | - Nathan Xie
- NeuroSpine Surgery Research Group, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney 2031, Australia
| | - Joseph Reidy
- NeuroSpine Surgery Research Group, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney 2031, Australia
| | - Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney 2052, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney 2031, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney 2031, Australia
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Bu J, Lei Y, Wang Y, Zhao J, Huang S, Liang J, Wang Z, Xu L, He B, Dong M, Liu G, Niu R, Ma C, Liu G. A Multi-Element Identification System Based on Deep Learning for the Visual Field of Percutaneous Endoscopic Spine Surgery. Indian J Orthop 2024; 58:587-597. [PMID: 38694692 PMCID: PMC11058141 DOI: 10.1007/s43465-024-01134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/10/2024] [Indexed: 05/04/2024]
Abstract
Background Lumbar disc herniation is a common degenerative lumbar disease with an increasing incidence. Percutaneous endoscopic lumbar discectomy can treat lumbar disc herniation safely and effectively with a minimally invasive procedure. However, the learning curve of this technology is steep, which means that initial learners are often not sufficiently proficient in endoscopic operations, which can easily lead to iatrogenic damage. At present, the application of computer deep learning technology to clinical diagnosis, treatment, and surgical navigation has achieved satisfactory results. Purpose The objective of our team is to develop a multi-element identification system for the visual field of endoscopic spine surgery using deep learning algorithms and to evaluate the feasibility of this system. Method We established an image database by collecting surgical videos of 48 patients diagnosed with lumbar disc herniation, which was labeled by two spinal surgeons. We selected 6000 images of the visual field of percutaneous endoscopic spine surgery (including various tissue structures and surgical instruments), divided into the training data, validation data, and test data according to 2:1:2. We developed convolutional neural network models based on instance segmentation-Solov2, CondInst, Mask R-CNN and Yolact, and set the four network model backbone as ResNet101 and ResNet50 respectively. Mean average precision (mAP) and frames per second (FPS) were used to measure the performance of each model for classification, localization and recognition in real time, and AP (average) is used to evaluate how easily an element is detected by neural networks based on computer deep learning. Result Comprehensively comparing mAP and FSP of each model for bounding box test and segmentation task for the test set of images, we found that Solov2 (ResNet101) (mAP = 73.5%, FPS = 28.9), Mask R-CNN (ResNet101) (mAP = 72.8%, FPS = 28.5) models are the most stable, with higher precision and faster image processing speed. Combining the average precision of the elements in the bounding box test and segmentation tasks in each network, the AP(average) was highest for tool 3 (bbox-0.85, segm-0.89) and lowest for tool 5 (bbox-0.63, segm-0.72) in the instrumentation, whereas in the anatomical tissue elements, the fibrosus annulus (bbox-0.68, segm-0.69) and ligamentum flavum (bbox-0.65, segm-0.62) had higher AP(average),while extra-dural fat (bbox-0.42, segm-0.44) was lowest. Conclusion Our team has developed a multi-element identification system for the visual field of percutaneous endoscopic spine surgery adapted to the interlaminar and foraminal approaches, which can identify and track anatomical tissue (nerve, ligamentum flavum, nucleus pulposus, etc.) and surgical instruments (endoscopic forceps, an high-speed diamond burr, etc.), which can be used in the future as a virtual educational tool or applied to the intraoperative real-time assistance system for spinal endoscopic operation.
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Affiliation(s)
- Jinhui Bu
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
| | - Yan Lei
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
| | - Yari Wang
- School of Computer Science, China University of Mining and Technology, Xuzhou, 221116 China
| | - Jiaqi Zhao
- School of Computer Science, China University of Mining and Technology, Xuzhou, 221116 China
| | - Sen Huang
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
| | - Jun Liang
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
| | - Zhenfei Wang
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
| | - Long Xu
- Bengbu Medical College, Bengbu, 233000 China
| | - Bo He
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
| | - Minghui Dong
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
| | - Guangpu Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
| | - Ru Niu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
| | - Chao Ma
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
| | - Guangwang Liu
- Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009 China
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, 221009 China
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Dürrbeck C, Gomez-Sarmiento IN, Androulakis I, Sauer BC, Kolkman-Deurloo IK, Bert C, Beaulieu L. A comprehensive quality assurance protocol for electromagnetic tracking in brachytherapy. Med Phys 2024; 51:3184-3194. [PMID: 38456608 DOI: 10.1002/mp.17017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Electromagnetic tracking (EMT) systems have proven to be a valuable source of information regarding the location and geometry of applicators in patients undergoing brachytherapy (BT). As an important element of an enhanced and individualized pre-treatment verification, EMT can play a pivotal role in detecting treatment errors and uncertainties to increase patient safety. PURPOSE The purpose of this study is two-fold: to design, develop and test a dedicated measurement protocol for the use of EMT-enabled afterloaders in BT and to collect and compare the data acquired from three different radiation oncology centers in different clinical environments. METHODS A novel quality assurance (QA) phantom composed of a scaffold with supports to fix the field generator, different BT applicators, and reference sensors (sensor verification tools) was used to assess the precision (jitter error) and accuracy (relative distance errors and target registration error) of the EMT sensor integrated into an afterloader prototype. Measurements were repeated in different environments where EMT measurements are likely to be performed, namely an electromagnetically clean laboratory, a BT suite, an operating room, and, if available, a CT suite and an MRI suite dedicated to BT. RESULTS The mean positional jitter was consistently under 0.1 mm across all measurement points, with a slight trend of increased jitter at greater distances from the field generator. The mean variability of sensor positioning in the tested tandem and ring gynecological applicator was also below 0.1 mm. The tracking accuracy close to the center of the measurement volume was higher than at its edges. The relative distance error at the center was 0.2-0.3 mm with maximum values reaching 1.2-1.8 mm, but up to 5.5 mm for measurement points close to the edges. In general, similar accuracy results were obtained in the clinical environments and in all investigated institutions (median distance error 0.1-0.4 mm, maximum error 1.0-2.0 mm), however, errors were found to be larger in the CT suite (median distance error up to 1.0 mm, maximum error up to 3.6 mm). CONCLUSION The presented quality assessment protocol for EMT systems in BT has demonstrated that EMT offers a high-accuracy determination of the applicator/implant geometry even in clinical environments. In addition to that, it has provided valuable insights into the performance of EMT-enabled afterloaders across different radiation oncology centers.
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Affiliation(s)
- Christopher Dürrbeck
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| | - Isaac Neri Gomez-Sarmiento
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| | - Ioannis Androulakis
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birte Christina Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
| | - Inger-Karine Kolkman-Deurloo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
| | - Luc Beaulieu
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
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Jitpakdee K, Boadi B, Härtl R. Image-Guided Spine Surgery. Neurosurg Clin N Am 2024; 35:173-190. [PMID: 38423733 DOI: 10.1016/j.nec.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The realm of spine surgery is undergoing a transformative shift, thanks to the integration of image-guided navigation technology. This innovative system seamlessly blends real-time imaging data with precise location tracking. While the indispensable expertise of experienced spine surgeons remains irreplaceable, navigation systems bring a host of valuable advantages to the operating room. By offering a comprehensive view of the surgical anatomy, these systems empower surgeons to conduct procedures with accuracy, while minimizing radiation exposure for both patients and medical professionals. Moreover, image-guided navigation paves the way for integration of other state-of-the-art technologies, such as augmented reality and robotics. These innovations promise to further revolutionize the field, providing greater precision and expanding the horizons of what is possible in the world of spinal procedures. This article explores the evolution, classification, and impact of image-guided spine surgery, underscoring its pivotal role in enhancing efficacy and safety while setting the stage for the incorporation of future technological advancements.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, 290 Jermjompol, Si Racha, Chonburi 20110, Thailand
| | - Blake Boadi
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA.
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Schmidt BT, Chen KT, Kim J, Brooks NP. Applications of navigation in full-endoscopic spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:429-437. [PMID: 37773448 DOI: 10.1007/s00586-023-07918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Advancement in all surgery continues to progress towards more minimally invasive surgical (MIS) approaches. One of the platform technologies which has helped drive this trend within spine surgery is the development of endoscopy; however, the limited anatomic view experienced when performing endoscopic spine surgery requires a significant learning curve. The use of intraoperative navigation has been adapted for endoscopic spine surgery, as this provides computer-reconstructed visual data presented in three dimensions, which can increase feasibility of this technique to more surgeons. METHODS This paper will describe the principles, technical considerations, and applications of stereotactic navigation-guided endoscopic spine surgery. RESULTS Full-endoscopic spine surgery has advanced in recent years such that it can be utilized in both decompressive and fusion surgeries. One of the major pitfalls to any minimally invasive surgery (including endoscopic) is that the limited surgical view can often complicate the surgery or confuse the surgeon, leading to longer operative times, higher risks, among others. This is the real utility to using navigation in conjunction with the endoscope-when registered correctly and utilized appropriately, navigated endoscopic spine surgery can take some of the guesswork out of the minimally invasive approach. CONCLUSIONS Using navigation with endoscopy in spine surgery can potentially expand this technique to surgeons who have yet to master endoscopy as the assistance provided by the navigation can alleviate some of the complexities with anatomic understanding and surgical planning.
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Affiliation(s)
- Bradley T Schmidt
- Department of Neurological Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Kuo-Tai Chen
- Department of Neurological Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chia-Yi, Taiwan
| | - JinSung Kim
- Department of Neurological Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nathaniel P Brooks
- Department of Neurological Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
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Chen Z, Meng L, Xiao Y, Zhang J, Zhang X, Wei Y, He X, Zhang X, Zhang X. Clinical application of optical and electromagnetic navigation system in CT-guided radiofrequency ablation of lung metastases. Int J Hyperthermia 2024; 41:2300333. [PMID: 38258569 DOI: 10.1080/02656736.2023.2300333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE To evaluate the clinical value of CT-guided radiofrequency ablation (RFA) in the diagnosis and treatment of pulmonary metastases under optical and electromagnetic navigation. METHODS Data on CT-guided radiofrequency ablation treatment of 93 metastatic lung lesions in 70 patients were retrospectively analyzed. There were 46 males and 24 females with a median age of 60.0 years (16-85 years). All lesions were ≤3cm in diameter. 57 patients were treated with 17 G radiofrequency ablation needle puncture directly ablated the lesion without biopsy, and 13 patients were treated with 16 G coaxial needle biopsy followed by radiofrequency ablation. There were 25 cases in the optical navigation group, 25 in the electromagnetic navigation group, and 20 in the non-navigation group. The navigation group was performed by primary interventionalists with less than 5 years of experience, and the non-navigation group was performed by interventionalists with more than 5 years of experience. RESULT All operations were successfully performed. There was no statistically significant difference in the overall distribution of follow-up results among the optical, electromagnetic, and no navigation groups. Complete ablation was achieved in 84 lesions (90.3%). 7 lesions showed incomplete ablation and were completely inactivated after repeat ablation. 2 lesions progressed locally, and one of them still had an increasing trend after repeat ablation. No serious complications occurred after the operation. CONCLUSIONS Treatment with optical and electromagnetic navigation systems by less experienced operators has similar outcomes to traditional treatments without navigational systems performed by more experienced operators.
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Affiliation(s)
- Zenan Chen
- PLA Medical School, Beijing, China
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liangliang Meng
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Radiology, Chinese PAP Force Hospital of Beijing, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Zhang
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaobo Zhang
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yingtian Wei
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng He
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xin Zhang
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Lewandrowski KU, Elfar JC, Li ZM, Burkhardt BW, Lorio MP, Winkler PA, Oertel JM, Telfeian AE, Dowling Á, Vargas RAA, Ramina R, Abraham I, Assefi M, Yang H, Zhang X, Ramírez León JF, Fiorelli RKA, Pereira MG, de Carvalho PST, Defino H, Moyano J, Lim KT, Kim HS, Montemurro N, Yeung A, Novellino P. The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States. J Pers Med 2023; 13:852. [PMID: 37241022 PMCID: PMC10221956 DOI: 10.3390/jpm13050852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center For Advanced Spine Care of Southern Arizona, 4787 E Camp Lowell Drive, Tucson, AZ 85719, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
| | - John C. Elfar
- Department of Orthopaedic Surgery, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Zong-Ming Li
- Departments of Orthopaedic Surgery and Biomedical Engineering, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Benedikt W. Burkhardt
- Wirbelsäulenzentrum/Spine Center—WSC, Hirslanden Klinik Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland;
| | - Morgan P. Lorio
- Advanced Orthopaedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA;
| | - Peter A. Winkler
- Department of Neurosurgery, Charite Universitaetsmedizin Berlin, 13353 Berlin, Germany;
| | - Joachim M. Oertel
- Klinik für Neurochirurgie, Universitätsdes Saarlandes, Kirrberger Straße 100, 66421 Homburg, Germany;
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Álvaro Dowling
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Roth A. A. Vargas
- Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13083-210, Brazil;
| | - Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba 80230-030, Brazil;
| | - Ivo Abraham
- Clinical Translational Sciences, University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA;
| | - Marjan Assefi
- Department of Biology, Nano-Biology, University of North Carolina, Greensboro, NC 27413, USA;
| | - Huilin Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China;
| | - Xifeng Zhang
- Department of Orthopaedics, First Medical Center, PLA General Hospital, Beijing 100853, China;
| | - Jorge Felipe Ramírez León
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Department of Orthopaedics Fundación Universitaria Sanitas, Bogotá 0819, Colombia;
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil;
| | - Mauricio G. Pereira
- Faculty of Medecine, University of Brasilia, Federal District, Brasilia 70919-900, Brazil;
| | | | - Helton Defino
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Jaime Moyano
- La Sociedad Iberolatinoamericana De Columna (SILACO), and the Spine Committee of the Ecuadorian Society of Orthopaedics and Traumatology (Comité de Columna de la Sociedad Ecuatoriana de Ortopedia y Traumatología), Quito 170521, Ecuador;
| | - Kang Taek Lim
- Good Doctor Teun Teun Spine Hospital, Anyang 14041, Republic of Korea;
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Seoul 06048, Republic of Korea;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ 85020, USA;
| | - Pietro Novellino
- Guinle and State Institute of Diabetes and Endocrinology, Rio de Janeiro 20270-004, Brazil;
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Ali R, Hagan MJ, Bajaj A, Alastair Gibson J, Hofstetter CP, Waschke A, Lewandrowski KU, Telfeian AE. IMPACT OF THE LEARNING CURVE OF PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY ON CLINICAL OUTCOMES: A SYSTEMATIC REVIEW. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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