Novel Applications of Spinal Navigation in Deformity and Oncology Surgery—Beyond Screw Placement

Abstract

Computer-assisted navigation has made a major impact on spine surgery, providing surgeons with technological tools to safely place instrumentation anywhere in the spinal column. With advances in intraoperative image acquisition, registration, and processing, many surgeons are now using navigation in their practices. The incorporation of navigation into the workflow of surgeons continues to expand with the evolution of minimally invasive techniques and robotic surgery. While numerous investigators have demonstrated the benefit of navigation for improving the accuracy of instrumentation, few have reported applying this technology to other aspects of spine surgery. Surgeries to correct spinal deformities and resect spinal tumors are technically demanding, incorporating a wide range of techniques not only for instrumentation placement but also for osteotomy planning and executing the goals of surgery. Although these subspecialties vary in their objectives, they share similar challenges with potentially high complications, invasiveness, and consequences of failed execution. Herein, we highlight the utility of using spinal navigation for applications beyond screw placement: specifically, for planning and executing osteotomies and guiding the extent of tumor resection. A narrative review of the work that has been done is supplemented with illustrative cases demonstrating these applications.

The clinical application of artificial intelligence technology in spinal surgery

“…[33,34] Presently, robotic assistance is mainly used in spinal fusion and instrumentation procedures and enables the completion of complex and high-risk operations, including spinal tumor resections and deformity corrections, that were previously challenging to perform. [35,36] This review mainly introduces two commonly used robots, American widely used one, MAZOR X STEALTH EDITIONTM (Medtronic, USA) and Chinese widely used one, TiRobot II (Beijing Tinavi Medical Technologies Co., Ltd., China).…”

Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series

“…The application of imaging techniques to spine tumor resection has enabled sophisticated multimodal preoperative imaging (MRI and CT) to be integrated with intraoperative navigation at the patient's bedside. [46][47][48][49][50] Such approaches have enabled more accurate osteotomy planes using 3D maps of the tumor relative to surrounding anatomy, useful for both intradural extramedullary and extradural neoplasms. Even more recently, augmented reality has been studied as another means of real-time tumor localization in the operating room, and could enable more minimally invasive approaches to smaller, particularly benign, extradural intramedullary tumors.…”

Advances and Challenges in Minimally Invasive Spine Surgery

“…With each iterative improvement in both software and hardware, robotics and navigation are seeing new indications. Such novelties include the usage of these technologies for interbody placement, osteotomy planning, and tumor resection [ 82 ]. While future surgeons will still need mastery of free-hand or fluoroscopy-based instrumentation, it is imperative that the new generation also train with these new technologies.…”