Current state of minimally invasive spine surgery

Abstract

Newer navigation protocols that rely on intraoperative CT registration have improved the accuracy of imaging models and allowed surgeons to rely less on fluoroscopy. Despite concerns regarding ionizing radiation exposure to the patient, use of CT navigation systems was found to reduce radiation exposure by more than 90% compared to traditional fluoroscopic guided percutaneous surgical techniques (1). Furthermore, the surgeon's exposure to radiation is almost eliminated, as the surgeon does not need to be close to the patient during the CT image registration.The accuracy of navigation has also undergone a huge amount of progress. In addition to higher quality registration, the use of stereotactic 3D cameras allows the system to predict relative position between instruments and anatomical landmarks in real time with higher reliability (2). Amiot et al. and Yu et al. (3,4). both demonstrated that freehand pedicle screw (PS) placement had a higher rate of error and reoperation compared to navigation assisted placement. The same results were reflected in a meta-analysis of 12 studies conducted by Shin et al. (5) However, many other meta-analyses in the literature have failed to demonstrate superiority of computer assisted navigation to free hand PS instrumentation perhaps due to the heterogeneity of studies included. The accuracy of navigation has also undergone a lot of progress. In additional to higher quality registration, the use of stereotactic 3D cameras allows the system to predict relative position between instruments and anatomical landmarks in real time with higher reliability (2). Amiot et al. and Yu et al. (3,4) both demonstrated that freehand PS placement had a higher rate of error and reoperation compared to navigation assisted placement. Shin et al. completed a meta-analysis of 12 studies which also reflected the same results (5). However, many other meta-analyses in the literature have failed to demonstrate superiority of computer assisted navigation to free hand PS instrumentation perhaps due to the heterogeneity of studies included.Navigation systems rely on the use of reference trackers to keep the registration image in sync throughout the operation regardless of the positioning of the patient. Multiple modalities of anatomic tracking are in use. Pin trackers that are inserted into bony landmarks allow for accurate mapping with relatively few trackers, however

Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

“…Even though fluoroscopy-guided pedicle screw fixation has demonstrated high accuracy, radiation exposure to surgeons and patients has been an issue. The application of CT-based navigation systems might reduce the risk of radiation exposures to surgeons and patients by more than 90% during the procedures while providing much higher accuracy for pedicle screw fixation [ 3 , 33 , 34 ]. Given MISS, especially MI-TLIF and MI-LLIF, are typically performed with percutaneous pedicle screw fixation, the application of navigation systems provides high reliability and safety.…”

“…Given MISS, especially MI-TLIF and MI-LLIF, are typically performed with percutaneous pedicle screw fixation, the application of navigation systems provides high reliability and safety. Many studies have reported that the current CT image-based navigation systems are highly reliable and thus can be applied to most MISSs to reduce operation-related complications, including reoperation rates [ 3 , 34 ]. One remaining problem is the navigation system cost, which should be balanced out as its usage rate increases.…”

“…The employment of robotics systems has increased in the field of spine surgery, given they provide precise, reliable, and effective procedures that can be performed quickly [ 3 , 34 , 35 ]. In combination with a navigation system, robotics systems theoretically promise more accurate pedicle screw fixation and less soft tissue damage.…”

“…With technological advancement, MISS for spine metastasis has become feasible, and thus has been considered as a new treatment option over traditional open surgery [ 38 ]. Several studies have reported equivalent functional outcomes and faster recovery with reduced morbidity, such as blood loss and surgical site infection [ 3 , 39 - 42 ].…”

“…Compared with traditional thoracolumbar open surgery for deformity correction, minimally invasive surgical approaches provide benefits to reduce approach-related tissue injury, intraoperative blood loss, and surgical site infection [ 6 , 43 ]. Several studies have reported favorable surgical MISS outcomes for treatment of adult spinal deformities as well as adolescent idiopathic scoliosis and neuromuscular scoliosis [ 3 , 43 , 44 ]. The authors corroborated the feasibility of posterior MISS for deformity correction, MI-TLIF, and MI-LLIF, by which it was possible to obtain sufficient correction of Cobb’s angle and pelvic obliquity [ 3 , 7 , 25 , 44 , 45 ].…”