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Intraoperative image guidance for cervical spine surgery
Sertac Kirnaz1, Harry Gebhard2,3, Taylor Wong1
1Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA.
Annals of Translational Medicine
|February 8, 2021
Summary
Advanced 3D navigation in cervical spine surgery significantly reduces complications and improves outcomes compared to traditional fluoroscopy. This technology offers enhanced precision for various surgical techniques, potentially replacing older methods.
Area of Science:
- Neurosurgery and Orthopedic Surgery
- Medical Imaging and Navigation Technology
Background:
- Intraoperative image-guidance in spinal surgery has evolved significantly since the 1990s.
- Technology advanced from fluoroscopy to intraoperative computed tomography (iCT)-based navigation systems.
- While common in thoracolumbar surgery, advanced navigation is increasingly used in cervical spine procedures.
Purpose of the Study:
- To review the applications of advanced image-guidance in cervical spine surgery.
- To describe the use of intraoperative neuro-navigation in surgical planning and execution for cervical procedures.
Main Methods:
- Review of surgical techniques including anterior cervical approaches, atlanto-axial fixation, subaxial instrumentation, and percutaneous cage implantation.
- Inclusion of minimally invasive posterior cervical foraminotomy (PCF) and unilateral laminotomy for bilateral decompression.
- Comparison of 3D navigation with conventional fluoroscopic guidance.
Main Results:
- 3D navigation significantly reduces screw malposition rates.
- Key benefits include decreased operative time, reduced blood loss, and lower radiation exposure.
- Complication rates are notably lower with 3D navigation compared to fluoroscopy.
Conclusions:
- 3D navigation offers superior outcomes in cervical spine surgery.
- The technology enhances safety and efficiency across a range of complex procedures.
- Advanced 3D navigation is poised to supersede conventional fluoroscopy in cervical spine interventions.
