53 Three-Dimensional Navigation in MISS

Bernhard Meyer and Yu-Mi Ryang

Summary

No other field in spine surgery is expanding at such a pace as spinal navigation technologies. While 3D spinal navigation with or without robotic assistance has already become the standard/default procedure for many spine surgeons, especially for MIS spinal instrumentation, iCT might be the next step to total navigation. Other promising technologies such as videoexoscopy, augmented and mixed reality may help expand surgical indications and overcome surgical limitations. This chapter gives insight into future perspectives of next level spine surgery.

Spinal navigation has greatly facilitated the use of minimally invasive spine surgery (MISS) worldwide. Numerous studies and meta-analyses were able to show the benefits of computer-assisted navigation (CAN) in spine surgery by improving accuracy and safety of open spine procedures1 and by decreasing the rate of pedicle screw-related complications and revision surgeries.^2,3 Intraoperative assessment of pedicle screw accuracy and immediate revision during the same surgery made it possible to further reduce the rate of revision surgeries. Another major benefit is the significant reduction of radiation exposure to surgeon, operating room (OR) staff and patient.^4,5 These advantages of CAN are even more important in minimally invasive spine procedures where anatomical landmarks for additional visual orientation are missing, which may result in increased complication rates and increased fluoroscopy and OR time. The benefits of CAN in MISS are therefore obvious^5,6 and generally accepted among experienced spine surgeons around the globe.

53.2 State-of-the-Art—Where Are We Heading?

53.2.1 iCT NAV and Total Navigation

Evolving from two-dimensional image guidance through three-dimensional, fluoroscopy-guided spinal navigation, the best navigation systems available today in terms of image quality, field of view, and gantry size are intraoperative computed tomography (CT) navigation systems (iCT NAV).

These rapid technological advances made it possible to greatly expand the indications for CAN in MISS from mere pedicle screw placement to other MISS procedures such as navigated interbody fusions, vertebral column and tumor resections, and spinal reconstruction procedures.^7,8 Härtl and colleagues thus coined the term “total navigation.” They used iCT NAV for skin incision and index level localization to verification of implant position and assessment of the extent of neural decompression. In this way, they were able to replace fluoroscopy in 75% of spinal procedures, of which the majority were MISS procedures, and to eliminate radiation exposure to the staff completely.⁵

53.3 Future Perspectives

53.3.1 Robotic Systems

Related posts:

IV MISS Techniques Surgical Tips, Tricks, and Techniques to Minimize Invasiveness; General Advice on How to Handle Fluoroscopy, Blood Loss, and Infection Rates Thoracic Vertebroplasty and Kyphoplasty Lateral Retropleural Thoracic Discectomy and Corpectomy Posterior Cervical Facet Cages DTRAX MIS-TLIF with Total Navigation and Expandable Interbody Cages

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