Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation

Area of Science:

• Minimally Invasive Spinal Surgery
• Thoracic Spine Procedures
• Image-Guided Surgery Technologies

Background:

• Video-assisted thoracoscopic surgery (VATS) has advanced for spinal disorder treatment.
• Early integration of image-guided surgery (IGS) faced challenges in reproducibility and adaptability.
• Second-generation IGS and VATS technologies aim to improve anterior thoracic minimally invasive spinal (MIS) procedures.

Purpose of the Study:

• To report the authors' experience with second-generation IGS and VATS for anterior thoracic MIS spinal procedures.
• To evaluate the safety and efficacy of combined IGS and VATS technologies in thoracic spine surgery.

Main Methods:

• Detailed description of the surgical procedure, including operating room setup and patient positioning (lateral decubitus).
• Spinal reference frame and portal placement, radiographic localization, and registration.
• Image-guided thoracoscopic discectomy using specialized surgical instruments.

Main Results:

• Successful combined IGS and VATS procedures in 14 patients, aiding anatomical localization.
• Common indications included disc herniation (8 patients), spinal tumors (4 patients), infection, and ossification of the posterior longitudinal ligament.
• 11 patients showed neurological improvement; 1 patient with postoperative weakness could ambulate with assistance. Chest tube drainage was generally short-term.

Conclusions:

• Intraoperative CT scanning and automatic registration represent significant advances in IGS.
• IGS combined with VATS is effective for thoracic discectomy, tumors, infection, and ossification of the posterior longitudinal ligament.
• The technique is useful, safe, and potentially applicable to other MIS procedures, offering an alternative to open thoracotomy.