Two surgeons in an operating room use a ZEISS surgical microscope system while viewing high-resolution imagery on ZEISS monitors during a medical procedure.
CHALLENGES IN SPINE SURGERY

Optimizing Visual Access in MISS

Optimizing Visual Access in MISS

For many years, the operating microscope has established itself as a benchmark for intraoperative visualization in advanced microsurgery, delivering exceptional magnification and illumination of spinal anatomy and pathologies. Its capacity to offer detailed visualization has made it a vital element of modern surgical practices.1

However, despite these advantages, there are inherent challenges with relying solely on microscopic visualization:  

  • Black line icon of an eye with concentric circles in the center, enclosed by four corner brackets, representing vision or focus for ZEISS.

    Visibility constraints

    The operating microscope's reliance on a straight line-of-sight can lead to missed critical information hidden behind tissue or corners, making it challenging to fully assess the surgical field and critical structures during procedures.2

  • Black line icon of an scapel

    Excessive dissection

    The narrow field of view may require additional soft tissue and bony dissection to achieve adequate visualization, which can complicate the procedure and increase the risk of converting to open surgery due to inadequate access.3,4

  • Black line icon of an person

    Ergonomic strain

    Adjusting the microscope to challenging angles for optimal viewing can lead to uncomfortable postures for the surgeon when working through the oculars only, causing physical discomfort and potentially affecting surgical performance and efficiency.5

These challenges are particularly pronounced in clinical applications such as minimally invasive spine surgery, where confined spaces make it difficult to position the microscope and instruments for optimal visualization.

A medical professional holds a ZEISS QEVO in a bright, sterile operating room environment.

ZEISS QEVO® provides efficient access to additional visual information

With the unique Micro-Inspection Tool QEVO from ZEISS, you can eliminate these blind spots in the microsurgical view and effectively look around corners. Whenever needed, plug it in to your ZEISS PENTERO 800 S to get an immediate endoscopic view on the anatomy without increasing the surgical footprint.

Providing efficient access to additional visual information – for greater certainty during your procedures.

ZEISS QEVO case example

During a lumbar microdiscectomy, where herniated disc material is removed to relieve nerve root compression, the ZEISS QEVO offers detailed visualization of neural tissues, allowing surgeons to examine the ventral aspect of the nerve root for additional disc fragments or compression sources.

Dr. Neil Badlani in a white lab coat standing in front of X-ray images.

In the lumbar spine, when doing a decompression such as a microdiscectomy, I use the QEVO to completely visualize the nerve root and follow its path into the foramen to assess for any signs of compression or hidden disc fragments that I might not see with the microscope alone.

Neil Badlani, MD Department of Orthopedic Spine, Orthopedic Sports Clinic, Houston, USA

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Medical professionals operate advanced surgical equipment with visual assistance from ZEISS QEVO® during a procedure in a modern operating room.

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  • 1

    Moisi et al. Advancement of Surgical Visualization Methods: Comparison Study Between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery. World Neurosurgery. 2017 Feb Pages 273-277. doi: https://doi.org/10.1016/j.wneu.2016.11.003

  • 2

    Nowak, S et al. Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results. 2024 August, 27(2):137-147. doi: 1227/ons.0000000000001093

  • 3

    Zhaojie Chin BMed et al. Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review & meta-analysis. The Spine Journal. 2024 June, Volume 24, Pages 1022-1033. doi: https://doi.org/10.1016/j.spinee.2023.12.009

  • 4

    Ridge et al. Heads-up Surgery: Endoscopes and Exoscopes for Otology and Neurotology in the Era of the COVID-19 Pandemic. Otolaryngol Clin North Am. 2020 Sep 29;54(1):11–23. doi: 1016/j.otc.2020.09.024

  • 5

    Alshabi et al. Exoscope Visualization, Navigation Guidance, and Robotic Precision in Spine Surgery. Journal of Minimally Invasive Spine Surgery and Technique 2025; 10(1): 22-33. doi: https://doi.org/10.21182/jmisst.2024.01508