This is a story of microtechnology influencing knife-less, blood-less, ultra-precise minimally invasive spine surgery.
The future is now. In the operating room, spine surgeons utilize the best strategies including, bloodless spine surgery, minimally invasive spine surgery, advanced bone grafting techniques such as Bone Morphogenic Proteins®, harvesting stem cells for use in surgery, spinal navigation to assess instrumentation placement, use of intraoperative CT scans, use of ultra-modern operating room tables, and spinal cord and nerve monitoring. We are always looking for new strategies to do better.
Facing an extremely difficult surgical upper cervical approach in a massive patient, I combined with Jordanian American oral and maxillofacial surgeon, Dr. Al Haitham Al Shetawi. Dr. Al Shetawi introduced me to the surgical electrocautery tool called the Colorado MicrosDissection needle (Stryker CMF, Kalamazzo, MI) and I have never stopped using it.
Knife-less Skin Incisions
The Colorado MicrosDissection needle consists of a 5 µm tip which creates high current density current for hemostasis or blood control at low power settings. (5 microns = 0.005mm = 0.0002 inches) This ultra-fine tool provides the opportunity to make a skin incision without a standard steel knife. Typically, the skin incision is made at 10 Watts. Deeper incision at the level of the fascia is at 20 Watts. Deepest spine incisions are conducted at 30 Watts. This tool provides a unique opportunity to stop bleeding in minimally invasive ports. For example, in kyphoplasty surgery, the approach entrances are 2 mm or so can be precisely made by the needle. If there is bleeding, then with conventional treatment a suture may be required. The Colorado microdissection needle is very apt at stopping any bleeding from these small port holes. Therefore, there may be no need for a suture.
Minimally Invasive Spine Surgery
Using the Colorado micro dissection needle allows for more precise dissections. Typically, spinal needles are placed before surgery to mark the locations of spinal vertebral bodies as identified by intraoperative x-rays. This affords the opportunity to therefore operate between needles. Smaller incisions are achieved by tugging the skin proximal and distal allowing for more visibility of the operative site.
Bloodless Spine Surgery.
The Colorado micro dissection needle routinely leads to significantly less blood loss. The ultra-fine, ultraprecise needle leads to stopping blood vessels more efficiently and delicately. With conventional technique when we revise and remove a standard lumbar scar from an old operation, it is not unusual to lose 300 mL of blood. With the Colorado microdissection needle no blood his lost. Similarly, with conventional technique massive redo reoperations routinely cause greater than 1000 mL of blood loss. With the Colorado microdissection needle many of these approaches can cost only about 100 mL of blood loss. The collective savings especially from massive redo surgeries in my experience is in the tens of thousands of mL of blood loss. This is on top of a usually very careful and blood protective practice.
The Colorado micro dissection needle has been studied by numerous academic bodies. This tool has been found to be safe and effective.