Neurosurgeon Daniel Lubelski reviews the innovations and enabling technologies used in spinal oncology treatment that offer decreased morbidity, faster recovery and overall better outcomes. These include stereotactic radiosurgery and separation surgeries using tubular systems and robotic tools to stabilize the spine when tumors are in difficult to reach areas, to name a few. These approaches and technologies offer patients a targeted approach and allow for greater collaboration with other surgeons to improve outcomes.
Hi, I'm Doctor Daniel Lubelski. I'm the director of spine tumor neurosurgery at Johns Hopkins University. Today, I'll be talking about some of the innovations and enabling technologies that we're using to treat patients to allow for decreased morbidity, faster recovery and overall better outcomes. The first technology is actually a technology that we do in collaboration with our radiation oncology. Colleagues, technologies like Cyber knife that allow for stereotactic radiosurgery have allowed us to do more targeted operations, decompressing critical structures like the spinal cord and allowing the radiation to treat the rest of the tumor. Historically, spinal tumor oncology and surgical oncology in general required large and very invasive operations to get rid of the whole tumor or much of the tumor to provide those outcomes. Those were fraught with very long hospital stays and significant morbidity and complications. Now, much of the field has shifted towards a more targeted approach with that, we've actually used some of the enabling technologies to change many of the surgical paradigms as well. We now can do short segment constructs using screws that have fenestrations, injecting cement through the screws to provide biomechanical stability without needing to do 678 or more levels in the fusion construct and providing a stability that is sufficient for the patient. We have shown as have others that oftentimes with short segment constructs that is sufficient to provide the stability one needs without hardware and instrumentation complications. The use of cement in general, whether it's through screws or whether it's through uh other modalities like kyphoplasty, which we do collaboratively with our interventional radiologists have also allowed palliation of instability pain. When the cancer erodes the two erodes the vertebral body using cement or cement through the screws to provide the same pain palliation. Another area that we have innovated and shifted towards using more minimally invasive technologies is doing the separation, surgeries, decompressing the spinal cord, but using tubular systems, placing the tube in the area that needs to decompress the spinal cord without having to do a large midline incision and taking down ribs and critical structures were able to just go through a tube and use a minimally invasive corridor to achieve the same decompression of the spinal cord and treat the rest of the cancer with the stereotactic radiation, combining tools like stereotactic radiation with some of the latest advances in minimally invasive technology, again, have allowed us to do smaller operations with less morbidity and better patient outcomes. Another area that we're innovating is the use of different types of robotic tools to help us stabilize the spine when a cancer erodes the stability of the spine using robotic tools for benign nerve sheath tumors such as Schwannoma or Meningioma when they're in difficult to reach locations, areas like the pre sacral space. The retro perineal cavities and the thoracic cavities historically have required very large operations, significant morbidity takedown of critical structures to access those tumors using robotic technologies and similar navigation tools. We're now able to work collaboratively with our general surgery, colorectal surgery, urology, and thoracic surgery colleagues to get into those spaces using specialized robotic tools while avoiding much of that morbidity. Here at Johns Hopkins in our spine tumor program, we work collaboratively with the greatest experts in each of their fields using the latest technologies and the most innovative approaches to lead to the best patient outcomes.
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