Image-guided endoscopic spine surgery: Part II: clinical applications

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Medical Technology

Background:

• Endoscopic spinal procedures are minimally invasive but have a steep learning curve and lack peroperative monitoring.
• Fluoroscopy has limitations including positioning challenges and radiation exposure.
• Existing navigation systems lack computed-tomography (CT)-based guidance for endoscopic spine surgery.

Observation:

• A novel methodology integrating CT-based image guidance with endoscopic spinal surgery was assessed.
• Two patients underwent endoscopic procedures with CT-based navigation: one for a thoracoscopic approach to a calcified disc herniation, and another for an endoscopic posterior approach to resect a sacroiliac osteophyte.
• A percutaneous reference frame was used for CT image registration to the patient's anatomy.

Findings:

• The CT-based navigational system proved reliable and effective in monitoring surgical progress during both endoscopic procedures.
• Navigation facilitated the achievement of surgical objectives in both the thoracoscopic and posterior endoscopic approaches.
• The system demonstrated technical feasibility and clinical applicability in complex endoscopic spinal interventions.

Implications:

• Image-guided endoscopic spine surgery is technically feasible and clinically applicable, offering a potential solution to the challenges of these minimally invasive techniques.
• This approach may enhance safety and efficiency in endoscopic spinal surgery by providing precise, real-time guidance.
• Further adoption of CT-based navigation could reduce the learning curve and improve outcomes in endoscopic spinal procedures.