Narrative review of intraoperative imaging guidance for decompression-only surgery

Decompression of the spine is defined as removal of bony and soft tissue structures in order to provide space for the spinal cord and/or nerve roots. This definition, however, underscores the dangers and complexity of safely providing anatomical space for these neurologic structures. Complications such as neurologic injury, vascular injury, and durotomy can make these procedures hazardous for the patient and surgeon. Furthermore, inability to fully decompress the neural elements will result in continued symptoms for patients. Intraoperative image guidance can provide important anatomical landmarks to perform these decompressive surgeries safely and efficiently. In particular, performing decompression surgery utilizing minimally invasive techniques with image guidance can allow for the least amount of muscle/soft tissue trauma possible. Within our article we outline research on the forefront of use of intra-operative imaging guidance for spine surgery and implications for decompression surgery. We also outline a case from the senior author to illustrate an example of image-guided spine decompression for cervical radiculopathy. Future technology, such as augmented reality and robotics, is also discussed in the context of image guided decompression. The authors hope this article shows surgeons that use of image guidance in specific clinical situations can allow for better/safer spinal decompression procedures.