Image-Guided Spinal Navigation for C1-C2 Instrumentation: Part I.

Abstract

Disorders of the spine are one of the oldest known human maladies, with descriptions found in ancient medical literature. As in many other areas of medicine, treatment of patients with these disorders has undergone rapid progress over the last century. Among treatment modalities, spinal instrumentation has been a significant technical advancement. Increased use of spinal instrumentation has spurred the need for accurate positioning of screws/instrumentation and enhanced stability of the construct. Traditionally, these have been placed using anatomic landmarks and intraoperative fluoroscopy. In patients with advanced degenerative disease or trauma, or in those with severe curvature deformity, anatomy can be of limited help. With intraoperative fluoroscopy, limited visualization can be a significant issue, especially in patients with a large body habitus. Image guidance, by providing live, accurate information for placement of instrumentation, significantly improves upon these issues. Image guidance has been used in neurologic surgery during recent decades. It was employed initially for intracranial applications, including treatment of brain disorders, with significant benefits and is now used routinely as an important adjunct tool in the operating room for intracranial neurologic surgery. Only more recently has image guidance been used in spine surgery.