Evolving Navigation, Robotics, and Augmented Reality in Minimally Invasive Spine Surgery

Abstract

Innovative technology and techniques have revolutionized minimally invasive spine surgery (MIS) within the past decade. The introduction of navigation and image-guided surgery has greatly affected spinal surgery and will continue to make surgery safer and more efficient. Eventually, it is conceivable that fluoroscopy will be completely replaced with image guidance. These advancements, among others such as robotics and virtual and augmented reality technology, will continue to drive the value of 3-dimensional navigation in MIS. In this review, we cover pertinent features of navigation in MIS and explore their evolution over time. Moreover, we aim to discuss the key features germane to surgical advancement, including technique and technology development, accuracy, overall health care costs, operating room time efficiency, and radiation exposure.

Augmented reality navigation in spine surgery: a systematic review

“…Notably, no study provided any cost-benefit analyses of using AR navigation. However, the financial benefits of navigation were presented in a recent review indicating that using navigation results in “buying-back” the investment in the long term [ 26 ]. There is no reason for AR systems to deviate from this pattern.…”

“…An ideal spinal navigation system should provide a time-efficient setup and registration, be easy to use, and allow visualization of the anatomy without distracting the surgeon or obscuring the surgical field [ 25 , 26 ]. The system must be accurate and preferably offer the possibility to confirm the results.…”

Commentary on “Robot-Guided Transforaminal Versus Robot-Guided Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease”

“…6 However, robotic-guided spinal procedures have not been adapted widespread yet since the robotic devices require greater set-up time, additional staff training, and high initial and maintenance costs. 2 In March 2021 issue of Neurospine, Staartjes et al 8 published an article to compare clinical outcomes following different robotic spine surgery techniques. The authors present a prospective cohort study that compares clinical outcomes and surgical variables of roboticguided minimally invasive transforaminal lumbar interbody fusion (TLIF) and roboticguided mini-open posterior lumbar interbody fusion (PLIF) procedures in patients with lumbar spinal stenosis and concomitant low-grade spondylolisthesis.…”

“…The advantage of robotic surgery is the emphasis it puts on preoperative planning of instrumentation. 2 Conversely, a drawback of robotic-guided spinal surgery is that the currently available robotic navigation systems only allow for pedicle screw placement and not for active navigation. However, we remain optimistic that in the future integration of 3-dimensional navigation technologies will create opportunities for the broader application of robotic navigation by assisting in additional steps of spinal procedures other than pedicle screw placement.…”

“…Over the past 3 decades, minimally invasive spine surgery has gained world-wide popularity due to equivalent outcomes to open approaches with significant reductions in intraoperative blood loss, operative time, and hospital stays [ 1 ]. The adaptation and evolution of image-guided stereotactic navigational technologies have resulted in the rapid transformation of minimally invasive spine surgical techniques [ 2 , 3 ]. Utilization of navigation technologies for percutaneous pedicle screw insertion and interbody cage placement has allowed more efficient workflow and increased safety in minimally invasive spine surgical procedures [ 4 , 5 ].…”