Ten techniques for improving navigated spinal surgery

Abstract

With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION) spinal surgery, we outline a number of measures which have been synthesised into a coherent operative technique. These include positioning, dissection, management of the reference frame, the grip, the angle of attack, the drill, the template, the pedicle screw, the wire, and navigated intrathecal analgesia. Optimizing techniques to improve accuracy allow an overall reduction of the repetition of the surgical steps with its associated productivity benefits including time, cost, radiation, and safety. Cite this article: Bone Joint J 2020;102-B(3):371–375.

Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis: A Retrospective Study

“…Free-hand pedicle screw instrumentation based on anatomic bony landmarks is fast and effective and carries a relatively low risk for neural deficits. The accuracy of navigation is limited due to movement between the reference and the instrumented level in the mobile growing spine often resulting in lateral deviation of the screw tip [ 9 ]. Patients with pedicle screws placed with CT-guided navigation have a lower rate of severely malpositioned screws and unplanned returns to the operating room than patients with pedicle screws placed with freehand/fluoroscopic technique [ 16 , 17 , 18 ].…”

“…High screw density helps restore thoracic kyphosis and correct spinal rotation [ 8 ]. Computer tomography (CT)—based navigation methods have improved results on the radiographic outcomes and reduced the number of misplaced screws significantly [ 9 , 10 ]. C-arm fluoroscopic imaging has been used for years and has enabled relatively accurate placement of pedicle screws.…”

“…Advanced intraoperative CT-based imaging and navigation increase both cost and operation time. Therefore, their use needs to be justified by improved safety and outcome [ 9 ].…”

Posterior Surgery in the Treatment of Craniovertebral Junction Deformity with Torticollis

“…Screw‐rod system fixation can provide immediate stability post operation, patients can perform early rehabilitation exercises, and pedicle screws are recommended as much as possible when the atlas pedicle can be placed with screws. For screw‐rod system fixation of complex deformities, to ensure that the screw implantation position is accurate and the depth is appropriate, especially without causing vertebral artery injury, the application of intraoperative CT navigation or robot‐assisted positioning can effectively increase the accuracy of screw placement 22 , 23 , 24 . Intraoperative spinal cord and vertebral artery injury can be seen in the relevant literature.…”

Safety and risk factors of TINAVI robot-assisted percutaneous pedicle screw placement in spinal surgery

“…Initially, the pedicle screws were placed in open methods with inevitable need for paravertebral muscle dissection resulting in excessive bleeding and trauma of soft tissues. With the wide acceptance of minimally invasive concepts, various insertion techniques, such as the percutaneous fluoroscopy-guided, patient-specific templateguided, the computer-assisted, and robot-assisted (RA) navigation techniques, have been designed to guide the pedicle screw placement for the enhancement of insertion accuracy, protection of proximal facet joint, and reduction of severe complication including neurological, vascular, and muscular injuries [5,6]. Among them, the widely used robots of SpineAssist, Renaissance, and Mazor X (Mazor Robotics Ltd., Caesarea, Israel) were reported to enable less damage to soft tissues, higher intra-pedicular accuracy of 85.0-98.2% [7][8][9][10][11][12][13], and lower rates of proximal FJV of 0-5% [9,13,14] with intraoperative navigation, automatic trajectory determination, and reduced manual errors [15].…”