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Review
. 2025 Apr 4:21925682251329340.
doi: 10.1177/21925682251329340. Online ahead of print.

Advancements and Challenges in Computer-Assisted Navigation for Cervical Spine Surgery: A Comprehensive Review of Perioperative Integration, Complications, and Emerging Technologies

Hania Shahzad  1 , Aziz Saade  1 , Shannon Tse  1 , Samuel Simister  1 , Anthony Viola 3rd  2 , Sathish Muthu  3   4   5 , Hardeep Singh  2 , Luca Ambrosio  6   7 , Javad Tavakoli  8 , Sven Yves Vetter  9 , Philip Louie  10 , Samuel Cho  11 , Sangwook Tim Yoon  12 , Amit Jain  13 , Hai Le  1 ; AO Spine Knowledge Forum Degenerative; AOSKFDegenerative@aofoundation.org
Affiliations
Review

Advancements and Challenges in Computer-Assisted Navigation for Cervical Spine Surgery: A Comprehensive Review of Perioperative Integration, Complications, and Emerging Technologies

Hania Shahzad et al. Global Spine J. .

Abstract

Study DesignA narrative review of the current literature on the application of Computer-Assisted Navigation (CAN) in cervical spine surgeries.ObjectiveTo analyze the perioperative integration, types of CAN systems, technical considerations, and clinical applications of CAN in cervical spine surgeries, as well as to assess the associated complications and potential strategies to minimize these risks.MethodsA comprehensive review of published studies between 2015 and 2024 was conducted to evaluate the usage, benefits, and challenges of CAN in cervical spine surgeries. The review covered perioperative integration, system types, complications, and emerging technologies, including augmented reality (AR) and robotics.ResultsThe use of CAN in cervical spine surgeries provides improved accuracy in screw placement and reduced neurovascular complications. However, the review identified several limitations, such as a steep learning curve, cost considerations, and potential inaccuracies related to cervical spine mobility.ConclusionsCAN offers significant benefits in cervical spine surgeries, including enhanced precision and reduced complications. Despite the current limitations, advancements in AR and robotics hold promise for improving the safety and effectiveness of CAN in cervical procedures. The future focus should be on overcoming the existing challenges to increase the adoption of CAN in cervical spine surgeries.

Keywords: augmented reality; cervical spine surgery; complications; computer-assisted navigation; robotics; surgical accuracy.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Robotic navigation for posterior cervical fusion. (A) Planned trajectories of C2, T1 and T2 pedicle screws using robotic navigation platform. Intraoperative photos of C2 pedicle screw (B) and T1 pedicle screw (C) placement using the robotic arm. Intraoperative lateral fluoroscopic imaging of the cervical spine status post C2-T2 posterior instrumented fusion.
Figure 2.
Figure 2.
Visual comparison of traditional open surgery vs. AR-assisted techniques in cervical spine procedures: improving accuracy and reducing complications.
Figure 3.
Figure 3.
Augmented reality surgical navigation of thoracic spine. With AR navigation, the operating surgeon looks directly at the patient and visualizes the patient’s anatomy in 3D through a wearable transparent headset (A). The trainees or assistants also participate and visualize the surgery through similar headsets. (B). FDA-approved spine head-mounted display AR navigation systems.
Figure 4.
Figure 4.
CT-guided navigation in a child with complex congenital cervical deformity. The reference array (*) is attached to the Mayfield cranial stabilization system (A), and sterile prepping and draping is performed around the array (B). The head of bed is turned 180 degrees away from anesthesia to facilitate intraoperative CT imaging and navigation. Intraoperative photo of thoracic pedicle screw (C) placement using CT navigation.
See this image and copyright information in PMC

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