Intraoperative Navigation Enhances Outcomes of Pediatric Spine Surgery

Spine surgery requires extraordinary precision. Complex spine deformities in young children present a particular technical challenge. Intraoperative navigation is one of many tools used by the pediatric spine surgeons at NewYork-Presbyterian/Morgan Stanley Children’s Hospital/Columbia University Medical Center to optimize outcomes for young patients.

“Surgical navigation has become a reality in the treatment of pediatric spine disorders,” said Michael G. Vitale, MD, MPH. “We have taken the surgical navigation techniques developed for adult patients and adapted them to the smaller anatomy of the pediatric spine. This technology has been around for a while, and we are now seeing an opportunity to adapt it to the special needs of our patients.”

Intraoperative Navigation Benefits

Dr. Vitale, Chief of Pediatric Spine and Scoliosis Surgery at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, leads the busiest pediatric spine surgery group in New York City, offering the full gamut of non-operative and operative choices for children with spinal deformities. “Surgical navigation is the newest addition to our toolbox of treatment options for children with scoliosis,” explained Dr. Vitale.

“Surgical navigation is the newest addition to our toolbox of treatment options for children with scoliosis,” explained Dr. Vitale.

That toolbox also includes many techniques for the treatment of early-onset scoliosis, such as growing rods and VEPTR, anterior vertebral stapling to reverse scoliosis in the growing child, and Mehta casting for infantile scoliosis. Surgical navigation relies on the use of three-dimensional fluoroscopic imaging in the operating room, connected to a BrainLab computer.

“We can scan the patient intraoperatively, see the anatomy in the OR, and use that information to navigate the placement of instrumentation that needs to be positioned precisely,” Dr. Vitale explained.

Intraoperative Navigation Increases Patient Safety

This method has allowed surgeons to achieve the highest possible safety margin on the many complex patients who are referred to NewYork-Presbyterian/Morgan Stanley Children’s Hospital. Dr. Vitale’s surgical navigation program was extensively highlighted in the 2012 “Best Doctors” issue of New York Magazine. Surgical navigation allows him and his fellow surgeons to measure screws and other instrumentation in the OR and provides them with more control during surgery than they’ve ever had before. The operating time is often reduced, typically by about 20 percent (a number which varies among patients and procedures), while enhancing patient safety by permitting the surgeon to avoid injuring nearby healthy tissues.

“Surgical navigation not only enables us to operate more quickly, but also more safely because we can see exactly where our instruments are going,” said Dr. Vitale. “Everything we do is driven by our intent to maximize safety.”

That intent has resulted in one of the lowest postoperative infection rates in the nation – achieved not only with the use of navigation, but also a dedicated Quality Committee, led by Pediatric Nurse Practitioner Jen Crotty. The Committee’s main focus is on quality of care and enhanced patient outcomes.

“We have built an infrastructure around quality and created a quality dashboard with checklists to provide the best care to each patient,” Dr. Vitale noted. “Our use of surgical navigation is just one component of our broader‘best in breed’ approach to pediatric spine surgery.”

Rising Tide Lifts All Boats

Surgical volume in the practice has increased by 20 percent per year since his arrival 11 years ago. “Volume very much drives quality and allows us to develop standardized processes aimed at maximizing the care of our patients,” he added.

Dr. Vitale’s partners – Joshua E. Hyman, MD, Benjamin Roye, MD, David P. Roye, Jr., MD, and Charles Popkin, MD – are exploring the use of surgical navigation in other areas of pediatric orthopaedics, including hip and knee surgery and sports medicine. Dr. Vitale concluded, “We’re just scratching the surface in seeing how we can use surgical navigation to improve the care of children undergoing orthopaedic surgery.”