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Minimally Invasive Spine Surgery pp 83–92Cite as

Image Guidance in Minimally Invasive Spine Surgery

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Abstract

Image guidance (IG) can serve as a very important adjunct to the surgeon during minimally invasive spine surgery (MISS). There is robust data showing that IG decreases the incidence of suboptimal screw placement and more recent data that IG may decrease the incidence of neurological complications and need for reoperations following thoracolumbar instrumentation while improving workflow. IG is invaluable in cases of severe deformity or other altered anatomy as well as for the intraoperative training of residents and fellows. Indications for its use continue to expand with a growing body of literature justifying its use in not only guiding thoracolumbar pedicle screw placement but also cervical and pelvic instrumentation as well as spinal tumor resection. IG offers the further benefit of minimizing occupational exposures to ionizing radiation for the surgeon and OR staff. Future studies will help to modify imaging protocols in IG to also minimize patients’ radiation exposure.

As the use of IG in spine surgery continues to expand, its value in improving surgical accuracy and clinical outcomes must be weighed against concerns over cost and radiation exposure. Our personal experience has shown the technology to be both efficient and cost-effective by reducing screw revision rates and reducing occupational radiation exposures. Further research will continue to clarify the answers to these questions and better delineate situations where IG may be particularly beneficial in spine surgery.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA

    Ryan B. Kochanski & John E. O’Toole

  2. Department of Neurosurgery, Hartford Healthcare Medical Group, New Britain, CT, USA

    Hussein Alahmadi

Authors
  1. Ryan B. Kochanski
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  2. Hussein Alahmadi
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  3. John E. O’Toole
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Corresponding author

Correspondence to John E. O’Toole .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

True/False

  1. 1.

    While a number of studies have shown that image guidance increases thoracolumbar pedicle screw placement accuracy, there are currently no studies that have shown an improvement in clinical outcomes when compared to either freehand or two-dimensional fluoroscopic techniques.

  2. 2.

    Older image guidance systems used a patient’s preoperative CT scan which required intraoperative registration to specific anatomic landmarks in order to provide real-time navigation.

  3. 3.

    Intraoperative multi-slice helical CT scan provides better soft tissue resolution than cone-beam three-dimensional fluoroscopy.

  4. 4.

    Research has conclusively shown that image guidance systems reduce radiation exposure to both the surgeon and the patient in comparison to two-dimensional fluoroscopic techniques.

Answers

  1. 1.

    False

  2. 2.

    True

  3. 3.

    True

  4. 4.

    False

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Kochanski, R.B., Alahmadi, H., O’Toole, J.E. (2019). Image Guidance in Minimally Invasive Spine Surgery. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_8

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  • Online ISBN: 978-3-030-19007-1

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