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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 , 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.