Introduction: The surgical operating microscope (OM) has been the mainstay of modern microneurosurgery. However, this system is expensive, cumbersome, and is ergonomically disadvantageous. The Video Telescope Operating Monitor (VITOM) is a novel telescope based system providing high definition images of the operative field. We set out to characterize the efficacy of this system in spinal surgery.

Methods: Patients requiring complex spinal procedures were excluded from the study. A 10mm diameter rigid lens telescope with a focal distance of 200mm attached to a 3-chip high definition digital camera with high definition video monitor was placed in front of the surgeon. A pneumatic scope holder was employed to position the scope. Operative time, complications, hospital stay, and long-term follow-up were assessed and compared using a paired t-test to case-matched controls. Surgeons were also asked to objectively assess the ease of use, optical quality and overall experience with the VITOM system.

Results: The mean ± standard deviation age of the VITOM cohort was 63 ± 15 years ( 66 ± 15 years for case matched controls). Patients underwent either single level decompression (n=3), two-level decompression (n=6), single level TLIF (n=7), or two level TLIF (n=2) using the VITOM. There was no statistical difference in average operative time (p=0.38) with hospital stay being equivocal for the VITOM (3 days) and OM (2.8 days) (p=0.75). Ease of use, image quality, maneuverability in the operating room, and surgeon comfort were objectively assessed to be advantageous when using the VITOM.

Conclusions: The VITOM system for spinal surgery provides outstanding image quality and ease of manipulation that rivals the OM, with reduced cost and increased maneuverability with no difference in operative time, hospital stay, or major complications. Further refinement of this system may have widespread application in neurosurgery.

Patient Care: Use of the VITOM system in spinal surgery may allow for greater visualization with no increased morbidity or mortality.

Learning Objectives: 1. The understand the potential uses and advantages of the VITOM system over traditional OM in spinal neurosurgery

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