Intraoperative spinal navigation

Study Design. Review article. Objectives. To provide a detailed overview of current methods for intraoperative spinal navigation using image-guided surgical technology. Summary of Background Data. The development of novel intraoperative navigational techniques has been an important advancement in the field of spine surgery. These techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous, multiplanar views of spinal anatomy. They can be used for detailed preoperative planning and allow the spinal surgeon to track the position of surgical instruments in real time. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. Methods. The relevant medical literature was reviewed, as was the authors' clinical and laboratory experience with intraoperative spinal navigation. Results. Image-guided spinal instrumentation procedures in the cervical, thoracic, and lumbar spine have lower rates of screw misplacement than do those performed without image guidance. In a typical IGS spinal procedure, surgical instruments are tracked in the operating room, and their positions are superimposed onto preoperatively acquired computed tomography scans (CT-based image guidance) or intraoperatively acquired fluoroscopic images ( virtual fluoroscopy). A new development, the combination of isocentric C-arm fluoroscopy with computer-assisted image guidance, allows the C-arm to create intraoperative CT images that can be used for image-guided navigation without the need for a surgeon-dependent registration step. Each of these technologies has distinct advantages and limitations. Conclusions. Intraoperative spinal navigation has advanced rapidly in recent years, beneficially affecting a variety of surgical procedures. Future technological developments will widen its clinical application and minimize its shortcomings.