Innovation in Spine Surgery Image Guided Surgery

The first navigation systems for spine surgery were introduced in the mid 90’s to optimize pedicle screws insertion. Both technologies are still used: CT-based navigation and 2D fluoronavigation systems. Three new technologies were introduced in the late 2000’s and can be added to the orthopaedic intra-operative arsenal for spine surgery. The 3D isocentric fluoroscope is a new type of fluoroscope, able to provide intra-operative CT-like images without the need of registration process. With templating technology, patient’s CT data are used to simulate and plan preoperatively the pedicle screw trajectory on a computer workstation. A rapid prototyping technology provides templates that are intra-operatively attached to the back side of the spine at their appropriate position, thanks to the precise representation of the bony surface. Then, each drill can be carried out accurately, exactly where it has been planned. The small robots such as "Bone Mounted Robots" can be fixed directly within the operating field. With CT-based navigation technology, and a 3D – 2D registration process, they demonstrated their ability to help the surgeon to perform pedicle drilling with a high degree of accuracy in open or per cutaneous procedures.Meta-analyzes showed that 3D fluoroscopic navigation systems are more accurate than CT based and 2D fluoroscopic systems. In terms of radiation dose, 3D fluoroscopic navigation seems less radiating than conventional fluoroscopy, but this remains to be proven formally. The results for a large-scale clinical use of the bone-mounted robot and templates are not yet known and their clinical application field is being to be considered.