Research ArticleSpecial Issue Article

Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions

Fabian Sommer, Jacob L. Goldberg, Lynn McGrath, Sertac Kirnaz, Branden Medary and Roger Härtl
International Journal of Spine Surgery October 2021, 15 (s2) S74-S86; DOI: https://doi.org/10.14444/8142

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Figures

  • Figure 1
    Figure 1

    Overview and evolution of image-guided spinal surgery (IGSS). Imaging and navigation technologies are connected by planning software. Imaging and navigation technology evolve in tandem. Cone beam computed tomography (CT) scanners are C-arm-based imaging platforms that obtain multiple images through a “cone-shaped” x-ray beam during a 190° rotation around the patient. Examples are the O-arm (Medtronic, Dublin, Ireland) or the Ziehm RFD3D (Ziehm Imaging GmbH, Nuremberg, Germany). Intraoperative fan beam CT scanners such as the AIRO (Brainlab AG, Munich, Germany) are portable CT platforms that emit a fan-like x-ray that is detected by a linear detector array. Robotic spinal navigation requires preoperative planning of screw positions, which limits its utility to the portion of the case in which screws are placed. By contrast, active navigation allows the surgeon to incorporate the benefits of navigation in each stage of the case from incision planning to bony resection to hardware implantation. Augmented reality (AR) and virtual reality (VR) expand the role for IGSS into more complex surgical procedures but also into the fields of surgical training and patient education.

  • Figure 2
    Figure 2

    Fluoroscopic-based two-dimensional navigation for pedicle screw placement (Kick system, Brainlab).

  • Figure 3
    Figure 3

    Technology systems for three-dimensional intraoperative computed tomography: fan beam computed tomography (FBCT) (A) and cone beam computed tomography (CBCT) (B and C).

  • Figure 4
    Figure 4

    (A) “Total navigation” with intraoperative three-dimensional computed tomography (iCT) for single lateral position transpsoas surgery. (B) Lateral position pedicle screw placement. (C) Direct decompression in lateral position via tubular minimally invasive surgical approach.

  • Figure 5
    Figure 5

    Example of an augmented reality-assisted spinal tumor resection in the lumbar spine. (A) Preoperative magnetic resonance imaging (MRI) with tumor (arrow). (B) Fusion of preoperative MRI and intraoperative computed tomography (iCT) with marked tumor (blue). (C) Intraoperative microscope view with tumor shape and position projected in microscope (blue).

  • Figure 6
    Figure 6

    Examples of robots for spinal surgery, including Excelsius, Globus (left), Mazor X (middle), Cirq (Brainlab) (right).

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Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions
Fabian Sommer, Jacob L. Goldberg, Lynn McGrath, Sertac Kirnaz, Branden Medary, Roger Härtl
International Journal of Spine Surgery Oct 2021, 15 (s2) S74-S86; DOI: 10.14444/8142
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