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Review
. 2021 Jan;9(1):93.
doi: 10.21037/atm-20-1101.

Intraoperative image guidance for cervical spine surgery

Sertac Kirnaz  1 , Harry Gebhard  2   3 , Taylor Wong  1 , Raj Nangunoori  1 , Franziska Anna Schmidt  1 , Kosuke Sato  4 , Roger Härtl  1
Affiliations
Review

Intraoperative image guidance for cervical spine surgery

Sertac Kirnaz et al. Ann Transl Med. 2021 Jan.

Abstract

Intraoperative image-guidance in spinal surgery has been influenced by various technological developments in imaging science since the early 1990s. The technology has evolved from simple fluoroscopic-based guidance to state-of-art intraoperative computed tomography (iCT)-based navigation systems. Although the intraoperative navigation is more commonly used in thoracolumbar spine surgery, this newer imaging platform has rapidly gained popularity in cervical approaches. The purpose of this manuscript is to address the applications of advanced image-guidance in cervical spine surgery and to describe the use of intraoperative neuro-navigation in surgical planning and execution. In this review, we aim to cover the following surgical techniques: anterior cervical approaches, atlanto-axial fixation, subaxial instrumentation, percutaneous interfacet cage implantation as well as minimally invasive posterior cervical foraminotomy (PCF) and unilateral laminotomy for bilateral decompression. The currently available data suggested that the use of 3D navigation significantly reduces the screw malposition, operative time, mean blood loss, radiation exposure, and complication rates in comparison to the conventional fluoroscopic-guidance. With the advancements in technology and surgical techniques, 3D navigation has potential to replace conventional fluoroscopy completely.

Keywords: Navigation; cervical spine; fusion; robotics; unilateral laminotomy for bilateral decompression (ULBD).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1101). The series “Current State of Intraoperative Imaging” was commissioned by the editorial office without any funding or sponsorship. RH reports that he is a consultant for Ulrich, Brainlab, DePuy-Synthes and he has royalties from Zimmer. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Intraoperative screenshots present a C5 corpectomy case. The lateral aspect of the corpectomy is confirmed with navigation. Blue virtual shapes are used to localize C4–5 and C5–6 disc spaces.
Figure 2
Figure 2
Transarticular C1/2 screw positioning with Magerl technique, the entry points as well as the screw trajectory is planned with intraoperative 3D navigation.
Figure 3
Figure 3
C1 lateral mass and C2 pars screws positioning with Harms technique, the entry points as well as the screw trajectory is planned with intraoperative 3D navigation.
Figure 4
Figure 4
Intraoperative 3D navigation pictures showing the trajectory and position of the LMS.
Figure 5
Figure 5
Pedicle screw placement in the lower cervical and upper thoracic spine with intraoperative 3D navigation.
Figure 6
Figure 6
Intraoperative 3D navigation screenshots demonstrating the trajectory and ultimate target of the interfacet joint cage (A,B,C,D). Postoperative (E) lateral and (F) anteroposterior radiographs following bilateral interfacet joint cage implantation. With permission of ref. (87).
Figure 7
Figure 7
Intraoperative 3D navigation pictures presenting a PCF case. With permission of ref. (87).
Figure 8
Figure 8
Multi-level cervical disc disease and spinal canal stenosis. With permission of ref. (87).
Figure 9
Figure 9
Unilateral laminotomy for “over the top” bilateral decompression. Intraoperative 3D navigation facilitates adequate contralateral decompression. With permission of ref. (87).
See this image and copyright information in PMC

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