navigation surgery

G.S. Sapkas

1st Orthopaedic Department

University Hospital “ATTIKON”

Medical SchoolAthens University

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.

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:

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”

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

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

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

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.

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

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

Current usage of Spinal

Navigation and Intra-operative Imaging

Key spine procedures, challenges with traditional

surgery Posterior Cervical Fusion

C1-C2 fusion Pedicle screws

Posterior Thoracic Fusion (upper thoracic spine)

Thoracolumbar spine

Spinal trauma Minimally invasive

trauma (screws and rods percutaneously)

Pediatric and adult deformity

Posterior Lumbar Fusion

Degeneration of the lumbar spine

Minimally invasive lumbar fusion

Revision surgeries

Image guided Image guided spine surgery: spine surgery: state of the art state of the art

and future and future directionsdirections

Thorsten T. et al, Eur. Spine 2010

Review article

Based on a medline Based on a medline search total of 1.462 search total of 1.462 publications published publications published until October 2008 were until October 2008 were retrievedretrieved

276 papers were 276 papers were included in the analysis included in the analysis

Only two RCTs and one Only two RCTs and one meta-analysis have been meta-analysis have been retrievedretrieved

Concerning the most Concerning the most

popular application popular application of image guided of image guided approaches pedicle approaches pedicle screw insertion, screw insertion, the the evidence of clinical evidence of clinical benefitbenefit in the most in the most critical areas e.g the critical areas e.g the thoracic spine thoracic spine is still is still lackinglacking

In many other In many other areas of spine areas of spine surgery e.g. surgery e.g. ventral ventral spine surgery or spine surgery or tumor surgerytumor surgery, , image guided image guided approaches are still approaches are still in experimental in experimental stages stages

The technical The technical development of development of image guided image guided techniques has techniques has reached a high level reached a high level as the accuracies as the accuracies that can be achieved that can be achieved technically meet the technically meet the anatomical demandsanatomical demands

However there is However there is

evidence that the evidence that the interaction interaction between the between the surgeon surgeon (human factor) (human factor) and the navigationand the navigation system is a source system is a source of inaccuracyof inaccuracy

““ATTIKON” UNIVERSITY HOPSITALATTIKON” UNIVERSITY HOPSITAL