Image-guided spine surgery

Summary

Intra-operative computer assistance, by means of image interactive visualisation of surgical action, is a rather novel aspect of spinal surgery. The underlying concept is to incorporate preoperative 3D image data, such as computed tomography (CT) or MRI into the intra-operative procedure. This is achieved by visualising the actual position and orientation of surgical instruments relative to the operated anatomy on a computer monitor. The aim is to allow for a more precise and safer intervention. In principle, each navigation system consists of three components: the image data-set; the bony anatomy to be operated on; and a navigator, which links the two. Most research effort so far has been spent on developing image-guided insertion of transpedicular screws in the thoracolumbar and lumbosacral spine. Several navigational systems for these applications have successfully completed the step from the laboratory into routine clinical use and first promising results of their performance have been published. This paper explains the functional basics of such systems in general and describes those navigation tools that are available for use in spinal surgery. In addition, an alternative, recently-developed concept incorporating intra-operative imaging is presented.

Key Words:

• computer-assisted surgery
• image-guidance
• navigation
• stereotaxis