Combined neurosurgical and orthopedic training facilitates complex spinal surgery

Feb. 25, 2022

Mayo Clinic has neurosurgeons with combined neurosurgical and orthopedic fellowship training in spinal surgery. That dual expertise, available at each of the main campuses, underlies Mayo Clinic's approach to complex spinal procedures.

"The skills emphasized in neurologic surgery and orthopedic surgery are fundamentally different, but the two are synergistic and optimize care for patients," says Ian A. Buchanan, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida.

Spinal neurosurgeons at Mayo Clinic focus solely on spinal surgeries. "Most of them involve complex reconstructions. That fosters our extensive experience in managing difficult spinal problems," says Jeremy L. Fogelson, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota.

That expertise is applied to adult and pediatric patients who need spinal anomaly reconstruction and surgical treatment for spinal tumors, spinal trauma and scoliosis.

"We have created a seamless structure that is able to provide whatever treatment and adjuvant care that patients need, regardless of age or spinal condition," says Jamal McClendon, Jr., M.D., a neurosurgeon at Mayo Clinic in Phoenix/Scottsdale, Arizona.

Technology is another important part of Mayo Clinic's personalized approach. "Artificial intelligence, predictive analytics and patient-specific implants have ushered in a new era of personalized medicine. Ultimately, that leads to improved patient outcomes," Dr. Buchanan says. "We're availing ourselves of all of these novel technologies available to us."

Predicting compensatory mechanisms

Complex spinal surgery requires state-of-the-art imaging, to help with diagnosis and preoperative planning. "Achieving an accurate plan going into surgery leads to fewer surprises and better overall outcomes," Dr. Fogelson says.

Preoperative images are used to obtain customized spinal implants. Patient-specific implants avoid the need to notch and bend spinal rods during surgery, reducing the likelihood that rods will fracture or fail.

Augmented reality also can be used preoperatively to help surgeons understand the nuances of an individual's anatomy. "The ability of our neuroradiologists to create new modalities for visualization — whether in the metaverse or in real time — gives us a comprehensive understanding of an individual and that individual's condition before we actually make an incision," Dr. McClendon says.

During surgery, augmented reality can provide real-time 3D visualization of screw trajectories to minimize malpositioning. To further prevent complications, Mayo Clinic uses algorithms that predict the compensatory mechanisms likely to occur in an individual after spinal fusion.

"A single-level fusion — if done in a manner that isn't optimal for that patient's alignment — will initiate a cascade of degenerative changes along the spine that can lead to repeat surgeries," Dr. Buchanan says. "With predictive analytics, we're learning more about physiologic compensatory changes and how to minimize postoperative complications. It's an iterative process — what we learn from one patient informs what we will do for subsequent patients."

To further improve complex spinal surgery, Mayo Clinic is investigating the use of machine learning to predict the best candidates for certain spinal procedures. "The goal is to triage patients on that basis," Dr. Buchanan says.

Multidisciplinary and enterprisewide expertise allows Mayo Clinic specialists to collaborate on the management of complex spinal conditions. "Our approach to complex spinal surgery isn't an individual's opinion," Dr. Buchanan says. "It's a convergence of ideas among individuals — all of them trained in complex spine management — about what will be the best treatment plan for a patient."

For more information

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