Visible Light Navigation in Spine Surgery: My Experience With My First 150 Cases

Preoperative anteroposterior and lateral thoracolumbar spine radiographs of the patient in case 1. Cobb angle and kyphosis measurement shown.

7D Surgical System acquired image of surgical field of the patient in case 1.

A total of 1641 points matched to preoperative computed tomography at L3 in the above image for the patient in case 1. After the “flash” of structured light, the machine matches those points to the preoperative scan during registration. The image above is displayed on the monitor. Each green dot is a matched point, providing rapid visual feedback as to the adequacy of the registration.

Navigation of the left screw for the patient in case 1. Note real-time measurement of vertebral dimensions, thus eliminating the need for preoperative templating of pedicle dimensions. P = posterior; H = head.

Postoperative anteroposterior and lateral radiographs of the patient in case 1.

Anteroposterior and lateral radiographs demonstrating advanced spondylosis with cervicothoracic kyphosis in the patient described in case 2.

Structured light image of operative site of case 2 by the 7D Surgical System. H = head, R = right.

A total of 2751 points matched to preoperative computed tomography image at C3-C4 in case 2.

Intraoperative navigation of lateral mass screws in case 2 (P = posterior).

Postoperative anteroposterior and lateral radiographs of the patient in case 2.

Preoperative radiographs consisting of unbend right and left anteroposterior and neutral lateral radiographs of case 3.

Structured light image of operative site by 7-dimensional for case 3.

A total of 2073 points matched to the preoperative computed tomography image at T8 for case 3.

Navigation of the right T8 screw in case 3. It is evident from the axial image the left pedicle cannot be safely instrumented. P = posterior; H = head.

View of the operative field and our preferred positioning of the 7D Surgical System machine and monitor. Note that with this system, no imaging equipment comes between surgeon and patient.

Postoperative radiographs of the patient in case 3. Sublaminar bands were placed at the apex of the concavity to aid derotation of the spine, where the pedicle diameter was too small to allow screw placement. L = left, R = right.

Preoperative radiographs of the patient in case 4 demonstrating interspace narrowing and junctional kyphosis.

Structured light image of the operative field in case 4. The existing screws at T10 and T11 are visible, as well as the array clamped to T9. H = head, R = right.

Registration matching of 3376 discrete points on the dorsal elements results in dense green image (case 4).

Navigation of T7 screws in case 4. Note existing instrumentation is visible in the image.