Preoperative planning for intraoperative navigation guidance

Abstract

Intraoperative navigation for spinal procedures has continued to gain popularity. Numerous platforms are currently on the market and offer a spectrum of features. Preoperative considerations when utilizing this technology begin with understanding the fundamental concepts and methods of navigation.Several key factors including patient positioning, reference array placement, and sequence of instrumentation can help improve intraoperative navigation workflow when planned appropriately. The authors review current literature to help guide surgeon decision making when utilizing navigation. Additionally, tips and techniques for use of navigation are detailed to help avoid common surgeon pitfalls. In general, navigation platforms are classified based on image acquisition and degree of surgeon motion restriction during instrumentation. Imageless platforms often require preoperative images to be uploaded into the navigation system. Image-based systems rely on intraoperative imaging to ensure accuracy of its referencing software.The system then creates a three-dimensional model that allows for visualization of the navigated instrument within the surgical field. Active and passive navigation describe the degree of surgeon free-motion restriction when utilizing navigated instruments. Active navigation platforms, such as most robotic systems, prevent the deviation of the surgeon's instrument from a predetermined trajectory. Passive navigation does not restrict surgeon motion and the projected trajectory of the instrumented can be displayed on a three-dimensional model.

Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives

“…However, these methods introduced increased radiation exposure, trajectory failure, and other pitfalls that were primarily addressed with the coming together of robotics with navigation. Even with the limitations associated with stand-alone robotic assistance, studies have reported favorable results regarding the accuracy of pedicle screw insertions in the range of 94.5% and 99% [37,40,[50][51][52]. One study investigating floormounted robotic pedicle screw placement found pedicle screw accuracy in 229 patients with 1050 screws to be 96.4% [53].…”

“…Systems considered active navigation are restrictive to surgical movements that deviate from predetermined paths set in the presurgical planning stage of the procedure. Imagebased systems incorporating active navigation components, such as in robotics or drilling guides, utilize a predetermined trajectory set during the preoperative planning stage of the process [40].…”

Topographic anatomy and intraoperative USG-guided foreign bodies extraction of neglected Molotov cocktail victim: A rare case report

“…Since there are multiple foreign bodies in the patient's body, preoperative preparations are made to remove them. Topographic anatomy surgery planning uses optical markers placed at anatomical landmarks on the body [ 5 ]. In this method, a previously obtained CT scan is used to determine the location of these foreign bodies.…”

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

“…It is strongly necessary to assess the preoperative anatomical changes of cervical kyphosis using a 3D CT scan. For patients with severe cervical anatomical deformity, intraoperative CT navigation can enhance the safety of surgery ( Sabri and York, 2021 ). Successful lateral mass screw placement still highly depends on the surgeon’s experience.…”