Neuronavigation in minimally invasive spine surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Parallel advancements in image guidance technology and minimal access techniques continue to push the frontiers of minimally invasive spine surgery (MISS). While traditional intraoperative imaging remains widely used, newer platforms, such as 3D-fluoroscopy, cone-beam CT, and intraoperative CT/MRI, have enabled safer, more accurate instrumentation placement with less radiation exposure to the surgeon. The goal of this work is to provide a review of the current uses of advanced image guidance in MISS.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors searched PubMed for relevant articles concerning MISS, with particular attention to the use of image-guidance platforms. Pertinent studies published in English were further compiled and characterized into relevant analyses of MISS of the cervical, thoracic, and lumbosacral regions.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fifty-two studies were included for review. These describe the use of the iso-C system for 3D navigation during C1–2 transarticular screw placement, the use of endoscopic techniques in the cervical spine, and the role of navigation guidance at the occipital-cervical junction. The authors discuss the evolving literature concerning neuronavigation during pedicle screw placement in the thoracic and lumbar spine in the setting of infection, trauma, and deformity surgery and review the use of image guidance in transsacral approaches.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Refinements in image-guidance technologies and minimal access techniques have converged on spinal pathology, affording patients the ability to undergo safe, accurate operations without the associated morbidities of conventional approaches. While percutaneous transpedicular screw placement is among the most common procedures to benefit from navigation, other areas of spine surgery can benefit from advances in neuronavigation and further growth in the field of image-guided MISS is anticipated.</jats:p></jats:sec>

Neuronavigation in Small Animals

“…The techniques generally use CT imaging with natural fiducial markers that are exposed in the anatomic space. [33][34][35] These techniques are currently under investigation in the veterinary field, and preliminary pilot data have quantitatively shown the ability to place bicorticate implants in ideal bone purchase corridors without spinal column compromise. 36 Transphenoidal hypophysectomy (TSH) is frequently described in the human and veterinary literature but one of the primary limitations of this technique is the lack of consistent external anatomic landmarks that can indicate the safe surgical corridor to the hypophyseal sella.…”

Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

“…How to master this technique quickly, accurately and is a thorny problem facing in the clinical physician training. We found that computer-assisted navigation technology can significantly shorten the operation period, reduce the amount of blood loss and reduce the error during implantation of screws [5][6][7][8] . It is suggested that intraoperative navigation can significantly shorten the learning curve, reduce the time of screw implantation, reduce the amount of bleeding, improve the accuracy of pedicle screw implantation and avoid the risk of culture.…”

Novel Techniques in the Surgical Treatment of Acromegaly: Applications and Efficacy

“…However, the more minimally invasive the procedure becomes, the more reduced the overview provided. Thus, neuronavigation is increasingly used intraoperatively for the localisation of anatomical structures throughout cranial and spinal neurosurgery [32,33]. When he popularised transsphenoidal surgery, Hardy [34] introduced an image intensifier together with the operating microscope.…”