The Use of Navigation In Minimal Invasive Spine Surgery (MIS)

Abstract

Spine surgery is among the surgical specialities that is evolving tremendously and 
rapidly. The advancements in technology and diagnostic tools opened new era of spine surgery. 
The rapid growth in the implant industry delivered novel techniques, at the same time more 
confusion on the proper choice of surgical technique or implant. Although there is no consensus on the gold standard on many spine procedures, it’s acceptable to say that the conventional 
open techniques are the most widely used by spine surgeons. One of the issues of spine instrumentations is screw mal position that was as high as 42% in some reports.1
The advancement of spine surgery and the better knowledge in spine anatomy, biomechanics, imaging, and implants introduced a new concept of less invasive “key hole surgery” 
that’s called minimal invasive spine surgery “MIS”. The newer techniques promises less soft 
tissue injury during surgery and faster post-operative recovery. One of the major concerns 
with MIS is the increasing radiation exposure for both the staff and the patient.2
 to overcome 
this concern, computer-assisted navigation was introduced not only for reducing radiation exposure, but also to improve accuracy of implant position. Navigation has been used for brain 
surgery in the early 1990s.3
 This technology utilizes stereotactic technique where the surgical 
instruments are guided to the pathologic target and it was frame-based navigation. The advancement of technology delivered frame-less systems, when combined to MIS techniques it 
should lower the radiation exposure and increases accuracy.4,5 In a systematic literature review 
and meta-analysis,6
 it was clearly shown that the use of computer-assisted navigation significantly lowers the risk of pedicle perforation for the navigated screw insertion compared with 
non-navigated insertion for all spinal regions.