Abstract
Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Different techniques - each with specific advantages and disadvantages - are used in the cervical spine. A structured summary of different spinal navigation techniques and a review of the literature were done to discuss the advantages and disadvantages of specific navigation tools in the cervical spine. In cervical spine surgery, CAN increases the accuracy of pedicle screw placement, reduces screw mispositioning and leads to fewer revision surgeries. Due to the mobility of the cervical spine, preoperative CT followed by region matching or intraoperative CT are recommended. CAN increases pedicle screw placement accuracy and should be used in spinal instrumentation for the cervical spine whenever possible.
Highlights
Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery
Registration of pre- and/or intraoperative spinal imaging data with the intraoperative anatomy provides the surgeon with immediate visual feedback, as the planned position of the pedicle screw can be visualized embedded in the patient’s imaging
There are many studies investigating the effect of different CAN techniques on screw placement accuracy for the cervical spine. Among these are several comparative studies showing that CAN significantly reduces the rate of misplaced screws compared to freehand placement.[18,19,20,21,22,23]. This advantage appears to be even more evident in the cervical spine than it is in the thoracic or lumbar spine.[16,26] and it has been found for the upper cervical spine[22,30] and the subaxial cervical spine[19,20] as well as for lateral mass screws and pedicle screws.[18,19,21]
Summary
Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Given that at the cervical spine, pedicles are relatively small and relevant structures that are to be preserved are close (e.g., vertebral artery, spinal cord), the best possible imaging quality should be employed.
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