Image-guided surgery has gained acceptance since the 1970s, enhancing surgical procedures through improved navigation, planning, and patient outcomes. Techniques such as 'surgical navigation' allow for more accurate diagnoses and minimally invasive operations, resulting in shorter recovery times. However, while advancements in technology have made significant progress, evidence of clinical benefits for certain applications in spine surgery remains limited.

1. G.S. Sapkas
1st Orthopaedic Department
University Hospital
“ATTIKON”
Medical School
Athens University

2. Introduction to Image-Guided Surgery
 Since the mid-1970’s,
image-guided surgery
has emerged as an
accepted and clinically
appropriate alternative
to traditional surgery.

3. Surgical navigationSurgical navigation
 Revolutionized operating room
procedures
 Enhanced pre-operative
planning
 Improved intra-operative
effectiveness and efficiency
 Increased the speed of
post-operative recovery,
and
 Improved clinical outcomes
has:has:

4.  Modern image-guided surgery has
been described in the clinical
literature using a variety of terms
such as:
 “surgical navigation,”
 “computer assisted surgery,”
 “surgical stimulation,”
 “3-D computer surgery,”
 “surgical navigation”

5.  Using surgical
navigation methods,
physicians may make
more accurate
diagnoses
before and during
surgery.

6.  Advanced technologies provide
 computerized, three-dimensional
viewing
 so physicians and surgical teams
can precisely
locate and position
surgical instruments
in the anatomic field
and view the results
on their visual displays

7. As a result,
procedures are
shorter and
protocols are
improved.

8.  Surgical navigation
may also be less invasive
than traditional surgery
as surgeons may be
more accurate
using technologically
advanced devices
in place of (or in addition to)
the traditional hand-guided,
mechanical devices
during surgery.

9.  This allows for
an increased level
of patient safety
and
an overall reduction
in patient morbidity.

10.  In addition,
recent enhancements
to surgical
navigation technology
have enabled
new and more
minimally
invasive procedures
to be possible.

11. Current usage of
Spinal Navigation
and Intra-operative
Imaging

12. Key spine procedures, challenges with
traditional surgery
 Posterior Cervical Fusion
 C1-C2 fusion
 Pedicle screws
 Posterior Thoracic Fusion
(upper thoracic spine)
 Thoracolumbar spine

13.  Spinal trauma
 Minimally invasive
trauma
(screws and rods
percutaneously)

14. Pediatric and adult deformity

15. Posterior Lumbar Fusion
 Degeneration of the
lumbar spine
 Minimally invasive lumbar
fusion
 Revision surgeries

16. Image guided spineImage guided spine
surgery: state of the artsurgery: state of the art
and future directionsand future directions
Thorsten T. et al, Eur. Spine 2010
Review article

17.  Based on a medline search totalBased on a medline search total
of 1.462 publications publishedof 1.462 publications published
until October 2008 wereuntil October 2008 were
retrievedretrieved
 276 papers were included in the276 papers were included in the
analysisanalysis
 Only two RCTs and oneOnly two RCTs and one
meta-analysis have beenmeta-analysis have been
retrievedretrieved

18.  Concerning the mostConcerning the most
popular application ofpopular application of
image guided approachesimage guided approaches
pedicle screw insertion,pedicle screw insertion,
the evidence of clinicalthe evidence of clinical
benefitbenefit in the mostin the most
critical areas e.g thecritical areas e.g the
thoracic spinethoracic spine is stillis still
lackinglacking

19.  In many other areasIn many other areas
of spine surgery e.g.of spine surgery e.g.
ventral spine surgeryventral spine surgery
or tumor surgeryor tumor surgery,,
image guidedimage guided
approaches are stillapproaches are still
in experimentalin experimental
stagesstages

20.  The technicalThe technical
development of imagedevelopment of image
guided techniques hasguided techniques has
reached a high level asreached a high level as
the accuracies that canthe accuracies that can
be achieved technicallybe achieved technically
meet the anatomicalmeet the anatomical
demandsdemands

21.  However there isHowever there is
evidence that theevidence that the
interaction betweeninteraction between
the surgeonthe surgeon
(human factor)(human factor)
and the navigationand the navigation
system is a source ofsystem is a source of
inaccuracyinaccuracy

22. ““ATTIKON” UNIVERSITY HOPSITALATTIKON” UNIVERSITY HOPSITAL