Intraoperative Imaging Techniques in Spine Surgery

The conventional method of inserting pedicle screws (ie, plain radiography, standard 2D fluoroscopy, direct palpation) was found to be less accurate with cortical violation ranging from 10 to 50%. Small and variable anatomy of the cervical and thoracic spine poses a particular challenge, and it can lead to a devastating neurovascular complication. With recent advances in imaging technologies, such as computed tomography-based image guidance and isocentric C-arm fluoroscopy, surgeons are now able to visualize hidden pedicles and reduce screw misplacement. Using these various navigation systems, the rate of pedicle screw perforation can be decreased to less than 10% and potentially eliminate clinically significant complications and revision surgeries.