Sommer Fabian, Goldberg Jacob L, McGrath Lynn, Kirnaz Sertac, Medary Branden, Härtl Roger
Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York.
Int J Spine Surg. 2021 Oct;15(s2):S74-S86. doi: 10.14444/8142.
Image-guided spinal surgery (IGSS) underwent rapid development over the past decades. The goal of IGSS is to increase patient safety and improve workflow. We present an overview of the history of IGSS, illustrate its current state, and highlight future developments. Currently, IGSS requires an image set, a tracking system, and a calibration method.
Two-dimensional images have many disadvantages as a source for navigation. Currently, the most common navigation technique is three-dimensional (3D) navigation based on cross-sectional imaging techniques such as cone-beam computed tomography (CT) or fan-beam CT.
Electromagnetic tracking uses an electromagnetic field to localize instruments. Optical tracking using infrared cameras has currently become one of the most common tracking methods in IGSS.
The three most common techniques currently used are the point-matching registration technique, the surface-matching registration technique, and the automated registration technique.
Augmented reality (AR) describes a computer-generated image that can be superimposed onto the real-world environment. Marking pathologies and anatomical landmarks are a few examples of many possible future applications. Additionally, AR offers a wide range of possibilities in surgical training. The latest development in IGSS is robotic-assisted surgery (RAS). The presently available data on RAS are very encouraging, but further improvements of these procedures is expected.
IGSS significantly evolved since its inception and is becoming a routinely used technology. In the future, IGSS will combine the advantages of "active/freehand 3D navigation" with AR and RAS and will one day find its way into all aspects of spinal surgery, not only in instrumented procedures.
在过去几十年中，图像引导脊柱手术（IGSS）得到了快速发展。IGSS的目标是提高患者安全性并改善工作流程。我们概述了IGSS的历史，阐述了其当前状态，并强调了未来的发展方向。目前，IGSS需要一组图像、一个跟踪系统和一种校准方法。
二维图像作为导航源有许多缺点。目前，最常见的导航技术是基于锥形束计算机断层扫描（CT）或扇形束CT等断层成像技术的三维（3D）导航。
电磁跟踪利用电磁场来定位器械。使用红外摄像头的光学跟踪目前已成为IGSS中最常见的跟踪方法之一。
目前使用的三种最常见技术是点匹配配准技术、表面匹配配准技术和自动配准技术。
增强现实（AR）描述的是一种可以叠加到现实世界环境中的计算机生成图像。标记病变和解剖标志是许多未来可能应用中的一些例子。此外，AR在手术培训中提供了广泛的可能性。IGSS的最新发展是机器人辅助手术（RAS）。目前关于RAS的可用数据非常令人鼓舞，但预计这些手术还会有进一步改进。
自成立以来，IGSS有了显著发展，正在成为一种常规使用的技术。未来，IGSS将把“主动/徒手3D导航”的优势与AR和RAS相结合，并且终有一天会应用于脊柱手术的各个方面，而不仅仅是器械辅助手术。
