Image-Guided Navigation in Spine Surgery: Historical Advancements and Prospects for the Future

John Hoang^*
*Correspondence: John Hoang, Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA, Email:

Keywords

Spine • Osteoarthritis • Surgical

Introduction

The earliest forms of navigation in spine surgery were rudimentary, relying heavily on the surgeon’s anatomical knowledge and tactile feedback. Traditional open spine surgeries required large incisions to expose the anatomical landmarks, increasing the risk of infection and longer recovery times. In the late 20th century, the introduction of fluoroscopy provided a significant leap forward. Fluoroscopy allowed for real-time imaging using X-rays, enabling surgeons to visualize the spine during the procedure. However, it came with limitations such as exposure to ionizing radiation for both the patient and the surgical team, and it provided only two-dimensional images, which were often inadequate for complex spinal deformities and multi-level fusions. The development of CT and MRI in the 1970s and 1980s provided detailed three-dimensional images of the spine, allowing for better preoperative planning. Surgeons could now assess the intricate details of spinal pathology and plan their surgical approach more accurately. However, these imaging modalities were initially used only for preoperative planning and not for real-time navigation during surgery. Image-guided navigation has been associated with a reduction in surgical complications. By providing real-time feedback and enhancing the surgeon’s ability to visualize the anatomy, these systems help avoid critical structures such as nerves and blood vessels. A study published in the Journal of Neurosurgery: Spine reported a lower incidence of nerve injury and cerebrospinal fluid leaks in navigated spine surgeries compared to traditional methods [1,2]. The advent of image-guided navigation has facilitated the growth of Minimally Invasive Spine Surgery (MISS). These techniques involve smaller incisions, reduced tissue disruption, and faster recovery times compared to traditional open surgeries. Navigation systems allow for precise targeting of the pathology with minimal collateral damage, making MISS a viable option for a broader range of spinal conditions. Patients undergoing MISS typically experience less postoperative pain, shorter hospital stays, and quicker return to normal activities.

Literature Review

The introduction of intraoperative CT and MRI marked a significant milestone in spine surgery. Intraoperative CT allowed for real-time, high-resolution, three-dimensional imaging during surgery. This advancement improved the accuracy of screw placement and other instrumentation, reducing the risk of complications such as nerve injury or malpositioned hardware. Intraoperative MRI provided excellent soft tissue contrast, making it particularly useful in surgeries involving spinal tumors or deformities. However, the high cost and technical complexity limited the widespread adoption of intraoperative MRI. The 1990s saw the emergence of computer-assisted navigation systems, which integrated preoperative CT or MRI images with real-time intraoperative data. These systems used advanced algorithms to create a virtual 3D model of the patient’s spine, which could be superimposed on the surgical field. Surgeons could now navigate through the spine with greater precision, using tools that tracked their movements relative to the virtual model. The StealthStation by Medtronic, introduced in the mid-1990s, was one of the first commercially available systems and set the stage for further innovations. Optical tracking systems use cameras to track reflective markers placed on surgical instruments and the patient’s anatomy. These systems provide real-time feedback to the surgeon, allowing for precise navigation. The integration of optical tracking with preoperative imaging data enabled more accurate and minimally invasive procedures. However, optical systems required a clear line of sight and were susceptible to interruptions from surgical staff or instruments [3,4].

Discussion

Electromagnetic tracking systems emerged as an alternative to optical systems. These systems use electromagnetic fields to track the position of surgical instruments in real-time. They are less affected by line-of-sight issues and can be used in more complex surgical environments. The Axiem system by Medtronic, introduced in the early 2000s, utilized electromagnetic tracking and was widely adopted for spine surgery. The integration of robotics with image-guided navigation represents a significant leap forward in spine surgery. Robotic systems such as the Mazor Robotics Renaissance and the Globus Medical ExcelsiusGPS use advanced imaging and navigation technologies to assist surgeons in performing precise and minimally invasive procedures. These systems can plan the optimal trajectory for screws and other instrumentation, reducing the risk of human error. Robotic assistance has been shown to improve the accuracy of screw placement, reduce operative time, and enhance patient outcomes. Numerous studies have demonstrated that image-guided navigation improves the accuracy and precision of spinal instrumentation. The use of navigation systems reduces the risk of malpositioned screws, which can lead to nerve damage, spinal instability, and the need for revision surgery. A meta-analysis of randomized controlled trials found that the accuracy of pedicle screw placement was significantly higher in surgeries utilizing navigation systems compared to conventional techniques [5,6].

Conclusion

The development of advanced imaging modalities, such as intraoperative cone-beam CT and high-resolution ultrasound, holds promise for improving image-guided navigation. Cone-beam CT provides high-resolution, 3D images with lower radiation exposure compared to traditional CT. High-resolution ultrasound offers excellent soft tissue contrast and can be used intraoperatively to visualize critical structures. The integration of these modalities with navigation systems can provide surgeons with more comprehensive and detailed information during surgery. The future of spine surgery will also be shaped by personalized medicine and 3D printing. Personalized medicine involves tailoring surgical interventions to the individual patient’s anatomy and pathology. 3D printing can be used to create patient-specific implants and surgical guides, improving the precision and outcomes of spine surgery. Navigation systems can be integrated with 3D printed models to provide real-time guidance and ensure the accurate placement of implants. The COVID-19 pandemic has accelerated the adoption of telemedicine and remote technologies in healthcare. In the future, image-guided navigation systems could be operated remotely, allowing expert surgeons to assist or perform surgeries in different locations. Remote navigation could provide access to high-quality spine surgery in underserved regions and enhance global collaboration in complex cases. Image-guided navigation has transformed spine surgery, enhancing the accuracy, safety, and outcomes of these procedures. From the early days of fluoroscopy to the advent of computer-assisted navigation and robotics, the field has witnessed remarkable advancements.

Acknowledgement

None.

Conflict of Interest

None.

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