SPINAL NAVIGATION

Abstract

Stereotactic navigation in cranial surgery is a well-established technique, in routine clinical use since the turn of the century. The advent of computer guided stereotaxis since the early 1990’s has led to an explosion in applications for the technology in cranial surgery, with the development of new surgical techniques, minimal access and consequent claimed reduction in morbidity and mortality.

Computer guidance also allows application of stereotactic techniques in spinal surgery. Early interventions have concentrated on the insertion of pedicle screws with improvement in accuracy and certainty of optimal screw placement. The use of fluoroscopic guidance allows the insertion of percutaneous pedicle screws and truly minimal access fusion techniques for the lumbar spine. More recently the development of improved registration has allowed the application of this technology to thoracic spinal surgery and to the cervical spine. Percutaneous techniques for C1/C2 arthrodesis, image guided vertebrectomy and transoral surgery, have been reported. The technology allows the development of surgical techniques designed not only for individual pathology but adapted to the anatomy of the individual patient. Disadvantages include a significant learning curve, especially for cervical spine surgery, the cost and need for registration which may be time consuming. Advantages include claimed accuracy in decompression, hardware placement, minimal access techniques and a three-dimensional solution to what is essentially a three dimensional problem. More recently non-computer based navigation systems have become available with improved hardware placement without the problems associated with computer based systems.

The purpose of this paper is to review computer guided spinal surgery, present new techniques based on its application to the adult spine, discuss advantages and disadvantages of those techniques and present the results of studies on the new non-computer based navigation systems.