Intro: This is Daily Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): Spine surgery can be life-changing and transformational for patients. Today, our guest, Dr. Amandeep Bhalla, a board-certified, fellowship-trained orthopedic spine surgeon and Medical Director at Memorial Care Spine Health Center, is here to talk about the benefits and advancements of image-guided spine surgery and the transformative impact of these techniques on spine care and patient outcomes. Hello, Dr. Bhalla. So glad you're with us again today.

Amandeep Bhalla, MD: Good afternoon. Great to be with you.

Host: Always a pleasure. Let's dive right in. What is image-guided spine surgery and how does it differ from traditional spine surgery techniques?

Amandeep Bhalla, MD: Image-guided spine surgery has the added benefit of having the patient's specific anatomy projected on a screen in the operating room to help the surgeon accurately and safely perform spine surgery.

Host: Okay. And can you walk us through how image technology is used during spine surgery from planning to execution?

Amandeep Bhalla, MD: So, everybody's anatomy is different and surgeons are different. They have varying degrees of training and backgrounds. It's really wonderful when you have a technology available in the operating room during surgery. That can help the surgeon navigate that patient's specific anatomy. And what typically happens is while the patient's under anesthesia, images are acquired using an intraoperative CT scan. And those images are then run through a software protocol that allows for virtual navigation of the patient's anatomy. So, real time, the surgeon has a three-dimensional view of the patient's spinal column, which really helps the surgeon stay clear of critical structures while safely and effectively navigating through the spinal operation.

Host: Sounds super specific to each patient.

Amandeep Bhalla, MD: Correct. Exactly. That really is a key point.

Host: And what are the main benefits of using image-guided technology for patients? I mean, does it lead to quicker recovery times or better outcomes?

Amandeep Bhalla, MD: I think in instances where instrumentation is being planned, it helps more accurately place instrumentation, and it can also help create image projections that help you optimize the location of your instrumentation or even potentially use stronger, more robust instrumentation, because you have a better command of the anatomy. And that can help decrease the risk potentially for needing future spinal operations if good planning and execution is performed. I do think that if the surgeon has a really good sense of each patient's anatomy, it does help with the operation moving more quickly, more seamlessly, and that can decrease blood loss, infection rate, recovery time.

Host: Sure, that makes sense. Let's get a little visual. Can you describe some of the advanced tools and technologies used in image-guided spine surgery, like the O-arm or the ExcelsiusGPS?

Amandeep Bhalla, MD: One of the things I love about working at the Spine Health Center at Memorial Care Long Beach Medical Center is we have a whole robust platform. of advanced technology specific for spine surgery, and we lead in the local region with respect to the degree to which the facility has invested in these different technologies. So, you mentioned the O-arm as well as a robotic platform called ExcelsiusGPS. The hospital also has a 7D intraoperative navigation system, which is a camera-based image acquisition technology. So, we have these different types of platforms that surgeons can choose to use for their patients and having that different options of technologies really just adds more quivers for the surgeon to choose from, and I think that helps both the surgeon experience as well as the patient experience at the facility.

Host: Hey, the more arrows in the quivers, the better, right?

Amandeep Bhalla, MD: Exactly.

Host: Now, how does this technology help surgeons be more precise and minimize potential risks during really complex procedures?

Amandeep Bhalla, MD: Well, the key is visualization. You can just see more. So, the surgeon has a greater sense of where they are. It sounds scary, but it's far harder to "get lost" during surgery. I mean, you're really able to stay on top of the patient-specific anatomy and at all times can refer back to this roadmap that is projected virtually in the operating room.

Host: Got it. How about the recovery process? What does it look like after image-guided spine surgery? Are there any advantages compared to traditional surgery in terms of rehab?

Amandeep Bhalla, MD: Yeah, I think the recovery process really is multifaceted at the Spine Health Center and Memorial Care Long Beach Medical Center. It really starts with preoperative education. We encourage early mobilization of our patients. We do same-day mobilization of our patients, typically after surgery depending on the type of surgery. Our physical therapy and occupational therapy teams are dialed in from the get-go. And I think having all these different systems in place, in addition to having the latest tools and technologies in the operating room available to us, those in concert really do aid with the recovery process.

Host: What kind of training and expertise is needed for surgeons to perform image-guided spine surgery effectively?

Amandeep Bhalla, MD: You know, a lot of the newer generation of surgeons have had some experience in image-guided spine surgery. But the reality is the full gamut of whether it's young, newer surgeons or more experienced senior surgeons are all using to varying degrees different types of image-guided spine surgery technology at the Spine Health Center and Morocco Long Beach Medical Center. So, we do have a lot of different surgeons at varying stages of their career that are using the different technologies very well. I would add that each technology does typically require a little bit of onboarding and training and familiarity to see how the technology can help the surgeon during the operation. You definitely want to be very facile with it. You come the day of surgery and we do have protocols in place to make sure that surgeons are up to speed and leading in their competency with respect to the technology.

Host: Now, let's look to the future. What advancements do you foresee in image-guided spine surgery and how might they further improve patient outcomes?

Amandeep Bhalla, MD: Looking to the future, advancements that I foresee in image-guided spine surgery include decreasing the effective radiation dose to patients during the acquisition of images, also a smaller footprint in the operating room and more predictive analytics to see how, things that are being done during spine surgery today might affect other levels in the spine.

Host: Okay. And any use of AI?

Amandeep Bhalla, MD: Yeah. Actually, that last point, really the predictive analytics in helping guide the surgical team to a better understanding of what they might be doing. You know, let's say for example, if they're fusing L4-5 or correcting a deformity at L4-5, how that may affect the adjacent segment or the biomechanical forces seen at the adjacent segment at L3-4 or L5-S1. Also, I think predictive analytics can help by illustrating how much force is being applied, for example, between a rod and a set screw, such that it may be able to predict likelihood for mechanical loosening in the future.

Host: Well, that'd be useful.

Amandeep Bhalla, MD: You bet.

Host: Is there anything else you'd like to add?

Amandeep Bhalla, MD: No, I think, you know, I always encourage people to do their research, ask questions with their surgeons. Surgeons may choose to use a variety of different technologies based on their own experience as well as the condition they're treating the patient for. But I think an informed patient is a better served patient, and being educated on it and breaking down some of that information asymmetry is so key in having a great experience.

Host: Yeah, that is true, every single time. Well, thank you so much, Dr. Bhalla, for your time and your expertise today. We really enjoyed having you on the podcast.

Amandeep Bhalla, MD: It was great to be with you. And if people do wish to learn more about the Spine Health Center and Memorial Care Long Beach Medical Center, they may feel free to call 562-933-4014 or visit us at memorialcare.org/lbspine.

Host: Got it. Once again, that's 562-933-4014 or visit memorialcare.org/lbspine. That's all for this time. I'm Deborah Howell. Have yourself a great day.