Image guidance (IG) can serve as a very important adjunct to the surgeon during MISS. There is robust data showing that IG decreases the incidence of suboptimal screw placement. The ability of IG to decrease the incidence of neurological complications or need for reoperations following thoracolumbar instrumentation remains unclear. IG offers particular advantages in cases of severe deformity or other altered anatomy as well as for the intraoperative training of residents and fellows. 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.
How widespread IG ultimately becomes in spine surgery will be based on balancing improvements in surgical accuracy (and resultant improvements in clinical outcomes) with concerns over cost, efficiency, and radiation exposures. 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 is needed to clarify the answers to these questions and better define the true role of IG in spine surgery.
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