Opportune Situations for Spine Surgical Navigation
Spine navigation continues to evolve as a powerful tool not only for the treatment of complex spine surgery but also for improved efficiency, accuracy, and safety of common procedures and for greater ease in performing minimally invasive surgery (MIS). Once the basic principles of navigation are clearly understood, the entire team of nurses, surgical techs, radiology techs, and company reps, along with the surgeon, must be involved in the process of successful navigation. With this team and the navigation tools, the surgeon gains the ability to “see” inside the patient—where the tool is and where it might be directed—and can even save “plans” of where the tool was. The surgeon can use these tools with unlimited degrees of freedom of his own hands. This can be especially useful during MIS, which is typically limited by very restricted visualization of the anatomy and oblique approaches. Regarding screw placement alone, three-dimensional surgical navigation improves accuracy in MIS spine surgery by 99%.1 Thus, navigation allows for improved accuracy in MIS posterior lumbar interbody fusion, MIS lateral surgery, MIS cervical fusion and foraminotomy, screw length and diameter measurement, skull base surgery, and spinal osteotomy, among other procedures. Additionally, the ability to “see” the location of instrumentation on a screen allows the primary surgeon to maintain the highest level of safety while training other surgeons or working with an assistant.2 Finally, spine surgical navigation improves safety and understanding of complex anatomy, opening the possibilities of new and innovative surgical procedures with increased safety. Sacroiliac joint fusion is a prime example of complex anatomy that can be treated safely with navigation used to guide grafting of the joint and implant placement. In conclusion, spine surgical navigation has advanced dramatically from a simple tool for screw placement to an advanced tool, enabling more and more complex surgery with less invasiveness and added safety.