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Navigated Spinal Fusion

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Abstract

3D navigation options offer new opportunities for more precise navigation in spinal surgery, favor reduction of radiation exposure for the surgical team, and accelerate surgical workflow. Recently, the latest concept of “total navigation” using iCT NAV in spinal surgery has been introduced. Therefore, workflows have changed from what they were before using X-ray and fluoroscopy. Although several groups have described reduced radiation exposure for the surgical staff, fastest surgical workflows, and improved screw implantation accuracy, there is not enough evidence available to prove a significant benefit over the institutional costs.

Total navigation makes spine surgery safer and more accurate and enhances efficient and reproducible workflows. Fluoroscopy and radiation exposure for the surgical staff can be eliminated in the majority of cases.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hospital Egas Moniz-Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

    Ana Luís

  2. Department of Neurosurgery, New York-Presbyterian/Weill Cornell Medical Center, Weill Cornell Brain and Spine Center, New York, NY, USA

    Ana Luís, Rodrigo Navarro-Ramirez, Sertac Kirnaz, Jonathan Nakhla & Roger Härtl

Authors
  1. Ana Luís
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  2. Rodrigo Navarro-Ramirez
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  3. Sertac Kirnaz
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  4. Jonathan Nakhla
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  5. Roger Härtl
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Corresponding author

Correspondence to Roger Härtl .

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

  1. 1.

    What intraoperative imaging technologies are available? Mention at least four.

  2. 2.

    What method is still the most reliable and cost-effective?

  3. 3.

    Mention two limitations of the state-of-the-art technologies (iCT).

  4. 4.

    Mention the critical steps for a successful spine navigation case.

Answers

  1. 1.

    Conventional X-rays Fluoroscopy Intraoperative cone beam CT scanner (e.g., O-arm) Intraoperative fan beam CT (e.g., Airo)

  2. 2.

    Fluoroscopy

  3. 3.

    Costs/benefit Has not shown a significant improvement on clinical and/or radiological outcomes compared with conventional methods (fluoroscopy)

  4. 4.

    Localization Confirmation using anatomical landmarks If shifting is suspected, accuracy must be re-tested using anatomical landmarks Spinal navigation does not substitute mastering the anatomy

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Luís, A., Navarro-Ramirez, R., Kirnaz, S., Nakhla, J., Härtl, R. (2019). Navigated Spinal Fusion. 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_31

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_31

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  • Online ISBN: 978-3-030-19007-1

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