Navigation Techniques in Endoscopic Spine Surgery

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2022 Sep 8

PMID 36072476

Authors

Matthew J Hagan

Thibault Remacle

Owen P Leary

Joshua Feler

Elias Shaaya

Rohaid Ali

Bryan Zheng

Ankush Bajaj

Erik Traupe

Michael Kraus

Yue Zhou

Jared S Fridley

Kai-Uwe Lewandrowski

Albert E Telfeian

Affiliations

Soon will be listed here.

Abstract

Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice. Two types of navigation, optical and electromagnetic, may allow for widespread utilization of ESS by engendering improved orientation to surgical anatomy and reduced complication rates. The present review discusses these two available navigation technologies and their application in endoscopic procedures by providing case examples. Furthermore, we report on the future directions of navigation within the discipline of ESS.

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References

Sommer F, Goldberg J, McGrath Jr L, Kirnaz S, Medary B, Hartl R . Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions. Int J Spine Surg. 2021; 15(s2):S74-S86. PMC: 8532534. DOI: 10.14444/8142. View

Shin B, James A, Njoku I, Hartl R . Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine. 2012; 17(2):113-22. DOI: 10.3171/2012.5.SPINE11399. View

Liounakos J, Wang M . Lumbar 3-Lumbar 5 Robotic-Assisted Endoscopic Transforaminal Lumbar Interbody Fusion: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019; 19(1):E73-E74. DOI: 10.1093/ons/opz385. View

Jin M, Lei L, Li F, Zheng B . Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study. World Neurosurg. 2021; 147:e459-e467. DOI: 10.1016/j.wneu.2020.12.095. View

Farah K, Coudert P, Graillon T, Blondel B, Dufour H, Gille O . Prospective Comparative Study in Spine Surgery Between O-Arm and Airo Systems: Efficacy and Radiation Exposure. World Neurosurg. 2018; 118:e175-e184. DOI: 10.1016/j.wneu.2018.06.148. View

Siemionow K, Katchko K, Lewicki P, Luciano C . Augmented reality and artificial intelligence-assisted surgical navigation: Technique and cadaveric feasibility study. J Craniovertebr Junction Spine. 2020; 11(2):81-85. PMC: 7462141. DOI: 10.4103/jcvjs.JCVJS_48_20. View

Oyelese A, Telfeian A, Ziya L Gokaslan , Kosztowski T, Choi D, Fridley J . Intraoperative Computed Tomography Navigational Assistance for Transforaminal Endoscopic Decompression of Heterotopic Foraminal Bone Formation After Oblique Lumbar Interbody Fusion. World Neurosurg. 2018; 115:29-34. DOI: 10.1016/j.wneu.2018.03.188. View

Yao Y, Jiang X, Wei T, Yao Z, Wu B, Xu F . A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance. Eur Spine J. 2021; 31(1):46-55. DOI: 10.1007/s00586-021-06948-4. View

Nousiainen M, Omoto D, Zingg P, Weil Y, Mardam-Bey S, Eward W . Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique. J Orthop Trauma. 2012; 27(2):87-92. DOI: 10.1097/BOT.0b013e3182604b49. View

10.

Blattert T, Jarvers J, Schmidt C, Riesner H, Josten C . Anterior column reconstruction in thoracolumbar injuries utilizing a computer-assisted navigation system. Eur J Trauma Emerg Surg. 2016; 37(2):127-33. DOI: 10.1007/s00068-011-0082-9. View

11.

Elmi-Terander A, Burstrom G, Nachabe R, Skulason H, Pedersen K, Fagerlund M . Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging: A First In-Human Prospective Cohort Study. Spine (Phila Pa 1976). 2018; 44(7):517-525. PMC: 6426349. DOI: 10.1097/BRS.0000000000002876. View

12.

Pojskic M, Bopp M, Sass B, Kirschbaum A, Nimsky C, Carl B . Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci. 2021; 11(5). PMC: 8156391. DOI: 10.3390/brainsci11050646. View

13.

Pennington Z, Cottrill E, Westbroek E, Goodwin M, Lubelski D, Ahmed A . Evaluation of surgeon and patient radiation exposure by imaging technology in patients undergoing thoracolumbar fusion: systematic review of the literature. Spine J. 2019; 19(8):1397-1411. DOI: 10.1016/j.spinee.2019.04.003. View

14.

Lin Y, Rao S, Chen B, Zhao B, Wen T, Zhou L . Electromagnetic navigation-assisted percutaneous endoscopic foraminoplasty and discectomy for lumbar disc herniation: technical note and preliminary results. Ann Palliat Med. 2020; 9(6):3923-3931. DOI: 10.21037/apm-20-1956. View

15.

Hagan M, Syed S, Leary O, Persad-Paisley E, Lin Y, Zheng B . Pedicle Screw Placement Using Intraoperative Computed Tomography and Computer-Aided Spinal Navigation Improves Screw Accuracy and Avoids Postoperative Revisions: Single-Center Analysis of 1400 Pedicle Screws. World Neurosurg. 2022; 160:e169-e179. DOI: 10.1016/j.wneu.2021.12.112. View

16.

Zheng B, Shaaya E, Feler J, Leary O, Hagan M, Bajaj A . Endoscopic Techniques for Lumbar Interbody Fusion: Principles and Context. Biomed Res Int. 2022; 2022:4979231. PMC: 8957448. DOI: 10.1155/2022/4979231. View

17.

Hecht N, Kamphuis M, Czabanka M, Hamm B, Konig S, Woitzik J . Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO(®) CT scanner. Eur Spine J. 2015; 25(3):716-23. DOI: 10.1007/s00586-015-3814-4. View

18.

Cui G, Wang Y, Kao T, Zhang Y, Liu Z, Liu B . Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976). 2011; 37(10):891-900. DOI: 10.1097/BRS.0b013e31823aff81. View

19.

Wood M, McMillen J . The surgical learning curve and accuracy of minimally invasive lumbar pedicle screw placement using CT based computer-assisted navigation plus continuous electromyography monitoring - a retrospective review of 627 screws in 150 patients. Int J Spine Surg. 2015; 8. PMC: 4325487. DOI: 10.14444/1027. View

20.

Scarone P, Vincenzo G, Distefano D, Del Grande F, Cianfoni A, Presilla S . Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients. J Neurosurg Spine. 2018; 29(4):397-406. DOI: 10.3171/2018.1.SPINE17927. View