Imaging in Spine Surgery: Current Concepts and Future Directions

Abstract

Study Design: Narrative Review Objective: To review and highlight the historical and recent advances of imaging in spine surgery and to discuss current applications and future directions Methods: A PubMed review of the current literature was performed on all relevant articles that examined historical and recent imaging techniques used in spine surgery. Studies were examined for their thoroughness in description of various modalities and applications in current and future management. Results: We reviewed 97 articles that discussed past, present, and future applications for imaging in spine surgery. Although most historical approaches relied heavily upon basic radiography, more recent advances have begun to expand upon advanced modalities, including the integration of more sophisticated equipment and artificial intelligence. Conclusion: Since the days of conventional radiography, various modalities have emerged and become integral components of the spinal surgeon's diagnostic armamentarium. As such, it behooves the practitioner to remain informed on the current trends and potential developments in spinal imaging, as rapid adoption and interpretation of new techniques may make significant differences in patient management and outcomes. Future directions will likely become increasingly sophisticated as the implementation of machine learning, and artificial intelligence has become more commonplace in clinical practice.

Variation in Sagittal Alignment Parameters in Adult Patients before Spine Surgery: A Serial Imaging Study Using Antero-Posterior and Latero-Lateral Projections

“…Furthermore, EOS gives lower labor costs per examination due to the shorter examination time (248 s to complete EOS vs. 449 s for standard digital radiography) and greater patient comfort regarding noise, compared with standard digital radiographs [22]. For these reasons, EOS imaging is an attractive alternative to conventional radiography for spine or whole-body alignment evaluation [25].…”

Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications

“…Anteroposterior and lateral projections are conventionally performed; if possible, they also include upright weight-bearing position images, and extension and lateral bending may detect instrumentation instability [ 6 ]. Radiographs have limited soft tissue evaluation, low resolution, and only bidimensional features [ 7 ].…”

“…Figure 10 presents a classification of postoperative spine findings grouped by noninstrumented and instrumented spine complications. 8 BioMed Research International [6] Nondiagnostic in some scenarios Metal artifact Low three-dimensional features and soft tissue resolution [7] Computed tomography Excellent bone detail Superior 3D imaging Assessment of instrumentation [12] Fusion progress and bone graft incorporation [13] Metal artifact caused by a prosthesis [15] Cannot differentiate acute from chronic changes Overestimation of lucencies High radiation dose [34] Magnetic resonance imaging Superior for evaluating discs, soft tissues, and intradural and cord pathologies Detection and monitoring of infection or fluid collections No ionizing radiation [18][19][20] Magnetic artifacts [15,21] Known contraindications: pacemaker Unable to assess the cortical bone [43,45] SPECT/CT High sensitivity Osteoblast activity assessment Reduced metal artifacts [43,45] Low specificity Unable to assess disc herniation, root compression, stenosis, or listhesis [43] Positron emission tomography Detection of inflammation, infection, and spondylodiscitis [48] High-resolution images Adequate radiation dose [49] Limited anatomic information Not widely available Expensive [49] (a 9 BioMed Research International differently on imaging assessment. On CT analysis, during the acute phase, they are isodense to hyperdense [51], in the subacute period isodense, and at the chronic stage hypodense.…”

Video-assisted thoracoscopic image-guided spine surgery: evolution of 19 years of experience, from endoscopy to fully integrated 3D navigation

“…20 As new technology emerges with advanced imaging techniques, robotics, artificial intelligence, and machine learning, we will undoubtedly be able to visualize and treat a wider range of thoracic spine diseases thoracoscopically. 36 Other institutions have reported favorable outcomes and safety profile data for thoracoscopic discectomy. 37 Other applications to the fields of deformity correction and anterior instrumentation have been reported and serve as another potential avenue for expansion of this technology.…”