Kirnaz Sertac, Gebhard Harry, Wong Taylor, Nangunoori Raj, Schmidt Franziska Anna, Sato Kosuke, Härtl Roger
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA.
Department of Surgery, Canton Hospital Baden, Switzerland.
Ann Transl Med. 2021 Jan;9(1):93. doi: 10.21037/atm-20-1101.
Intraoperative image-guidance in spinal surgery has been influenced by various technological developments in imaging science since the early 1990s. The technology has evolved from simple fluoroscopic-based guidance to state-of-art intraoperative computed tomography (iCT)-based navigation systems. Although the intraoperative navigation is more commonly used in thoracolumbar spine surgery, this newer imaging platform has rapidly gained popularity in cervical approaches. The purpose of this manuscript is to address the applications of advanced image-guidance in cervical spine surgery and to describe the use of intraoperative neuro-navigation in surgical planning and execution. In this review, we aim to cover the following surgical techniques: anterior cervical approaches, atlanto-axial fixation, subaxial instrumentation, percutaneous interfacet cage implantation as well as minimally invasive posterior cervical foraminotomy (PCF) and unilateral laminotomy for bilateral decompression. The currently available data suggested that the use of 3D navigation significantly reduces the screw malposition, operative time, mean blood loss, radiation exposure, and complication rates in comparison to the conventional fluoroscopic-guidance. With the advancements in technology and surgical techniques, 3D navigation has potential to replace conventional fluoroscopy completely.
自20世纪90年代初以来，脊柱手术中的术中影像引导受到了影像科学各种技术发展的影响。该技术已从基于简单荧光透视的引导发展到基于术中计算机断层扫描（iCT）的先进导航系统。尽管术中导航在胸腰椎脊柱手术中更常用，但这种更新的成像平台在颈椎手术中迅速受到欢迎。本手稿的目的是探讨先进影像引导在颈椎手术中的应用，并描述术中神经导航在手术规划和实施中的使用。在本综述中，我们旨在涵盖以下手术技术：颈椎前路手术、寰枢椎固定、下颈椎内固定、经皮椎间融合器植入以及微创颈椎后路椎间孔切开术（PCF）和单侧椎板切开双侧减压术。目前可用的数据表明，与传统的荧光透视引导相比，使用三维导航可显著降低螺钉误置、手术时间、平均失血量、辐射暴露和并发症发生率。随着技术和手术技术的进步，三维导航有可能完全取代传统的荧光透视。
