Image Guidance for Spine Surgery

Since the introduction of image guidance in spine surgery in the 1990s, the field has grown dramatically. Early navigation systems were based on thin-cut preoperative computed tomography (CT); however, registration was time consuming and often inaccurate. This led to the development of more advanced systems relying on intraoperative image acquisition such as 2D fluoroscopy, cone beam CT, and most recently intraoperative CT and magnetic resonance imaging (MRI). Many surgeons have found that the use of image guidance in spine surgery is helpful in the placement of instrumentation, correction of spinal deformity, and spinal oncology. This is particularly true in cases using minimally invasive approaches and in complex cases with distorted anatomy where there are few reliable landmarks to orient the surgeon. Furthermore, this technology is shown to eliminate occupational radiation exposure and may provide a cost-effective strategy for increasing efficiency in the operating room.