Overview of Imaging, Robotics, and Navigation Technologies
New imaging systems, including the O-arm (Medtronic, Louisville, CO) and the Mobius Airo (Mobius Imaging, LLC, Shirley, MA), provide higher-quality intraoperative imaging and have proved effective in their seamless integration with navigation technologies. Documented evidence of improved screw accuracy has allowed the O-arm to become a widely accepted advancement. The debate that arises regarding the radiation dose received with the use of the O-arm and the C-arm can be challenged by the literature suggesting use of a pediatric protocol for the O-arm, which decreases the radiation dose by more than seven times when compared with the standard protocol. These innovative systems improve operating room efficiency by allowing fluoroscopy memory presets, three-dimensional reconstructions, lateral patient access, and a quick scanning speed of 13 seconds for high and standard definition images.
Complementary use of navigation systems such as the StealthStation (Medtronic) boasts advantages for both patients and surgeons by increasing accuracy, decreasing the number of revisions, and allowing minimally invasive techniques. Such systems benefit the surgeon by eliminating the need to wear lead. Image-guided spinal surgeries minimize operating room radiation, offer precise orientation to unexposed anatomy, and reduce surgical time and morbidity. They inform the surgeon regarding the screw entry point, the sagittal and axial trajectory of the screw, and the length and direction of the screw. Increasing evidence of improved screw placement accuracy with navigation may allow it to become a widely accepted procedure (Figure 1).
The latest technology that integrates the benefits of updated imaging and navigational capabilities is robotics. Data for the Renaissance Robotic Guidance system (Mazor Robotics, Orlando, FL) show pedicle screw placement accuracy ranging from 98% to 99%. However, a failure rate of 6% to 7% reflects the times opted for manual placement of screws over robotic guidance.
It is important to remember that all of the technologies discussed here have been developed to assist the surgeon—not to replace him/her—and no amount of technology can account for ignorance of spinal anatomy or basic knowledge. These technologies cannot make an incompetent surgeon good but will help a good surgeon become better.