History of Navigation Guided Spine Surgery

Spinal surgery has undergone a paradigm shift toward the use of minimally invasive techniques. This shift has been made possible by the dramatic evolution and implementation of spinal imaging techniques and technologies. The original methods of free-hand pedicle screw placement aided by single or biplanar fluoroscopy were enhanced by powerful computer software allowing surgeons to view "2-dimensional" (2D) projections based on fluoroscopic technology. Imaging technology and software further evolved to allow 3-dimensional (3D) navigation based on fan beam or cone beam computed tomography. With this evolution came improvements in pedicle screw accuracy and decreased levels of radiation exposure to the operating room staff. Computer generated 3D navigation can be integrated with robotics resulting in highly accurate robot assisted pedicle screw placement. Software advances have also allowed for the commercial availability of augmented reality (AR) and virtual reality (VR) operating room technology. These technologies hold promise in the realms of operating room safety and new paradigms in resident education.