Every year, MD Anderson’s surgeons perform more than 200 spine tumor operations. While some of the patients have primary spine tumors, almost 90% of them have metastatic cancer.
“After the lungs and liver, the skeleton is the third most common area where cancer spreads. And within the skeleton, the spine is the most common site,” explains Laurence Rhines, M.D., professor of Neurosurgery.
Managing spinal metastases is challenging. The treatment must be multimodal, multidisciplinary and tailored to each patient to provide the best results.
“Spine surgeries are complicated. When we remove tumors and stabilize the spine, we’re often putting in screws and making bone cuts very close to the spinal cord, nerves and other vital structures. We’re always trying to do that more safely,” Rhines says.
Evolution of spine surgery technology
Our newest building, The Pavilion, houses a state-of-the-art surgical suite with an intraoperative computerized tomography (IOCT) on rails.
Rhines was the first surgeon to use the IOCT suite, which has an operating table that’s positioned so a CT scanner can move on rails and scan the patient in real-time during surgery.
“This real-time imaging leads to more effective and accurate surgery for the patient,” Rhines says.
Historically, the safest way to surgically remove tumors and stabilize the spine was to take X-rays during surgery. But with that technique, X-rays expose the patient and the surgical team to radiation and only provide two-dimensional images.
Our surgeons recently have used intra-operative navigation based on the patient’s preoperative CT scan. This is where surgeons can register patients to their preoperative imaging and use that information to determine where to make cuts and place screws during surgery.
“CT scans are typically taken with patients lying on their backs, which poses a dilemma for spine surgeons,” Rhines says. “Most of the surgery we do is with patients lying on their chests. There’s quite a bit of shift in the anatomy and the alignment of the spine when you take a patient from her back to chest, and that creates error in the system. This forced us to live with a little inaccuracy in the operating room when we really needed extreme accuracy.”
A collaborative approach
The IOCT suite allows for that extreme accuracy. When MD Anderson started designing the IOCT suite eight years ago, Rhines saw an opportunity to make improvements.
“One of the challenges in spine surgery is the positioning of the patients. We take that very seriously,” Rhines says. “You don’t want to adversely affect the patient’s spinal alignment simply by putting them on the table.”
Rhines collaborated with a medical equipment manufacturer to make the world’s first low-profile prone positioning CT table.
The low profile frame allows the patient’s body to rest inside the frame rather than on top, allowing the body to be in the optimal position for a CT scan.
“Other manufacturers simply place a prone table top on the existing operating table, which creates a very thick table that must go through a relatively small CT bore. This can limit patient positioning inside the CT,” Rhines explains.
This table is also mobile. Most IOCT suites have a permanent fixed-base table in the room to accommodate a higher weight capacity at full extension. Our table base has an anchor that hooks into the operating room floor, increasing the weight capacity of the table when it’s fully extended while in use with the CT. This anchor can be retracted into the floor when the room isn’t being used for CT cases, allowing any service to utilize the room.
Rhines teamed up with industry leaders, surgeons, anesthesiologists and nurses to make sure the table’s design meets their needs.
Improving spine surgery for our patients
The custom table, combined with the latest innovations in navigation and image-guided technologies, will make spine surgeries more accurate and safe for our patients.
“It’s taken a long time to develop, but that’s given us a chance to really perfect and expand how we use intraoperative navigation. It’ll be interesting to see how the improved imaging will let us take that even further,” Rhines says. “I’m proud of this room and grateful to all the people who have helped us get to this point. We’re here to do our best for our patients, and this technology will help us do that.”
A longer version of this article originally appeared in Messenger, MD Anderson’s bimonthly employee publication.