What is Minimally Invasive Spine Surgery with Computer Assisted Navigation (CAN)?

Minimally invasive spine (MIS) surgery has been defined by a panel of experts as a procedure that “…by virtue of the extent and means of surgical technique results in less collateral tissue damage”. MIS surgery is also defined as reducing muscle damage, blood loss and post-operative pain. Therefore, MIS surgery relies on limited muscle disruption while still achieving desired surgical goals. Visualization can be through a smaller and narrower dissection in MIS cases. Image guided navigation during spinal surgery can be an invaluable assistant to MIS surgeons as it allows for a larger area of visualization of bony and soft tissues through a smaller area of surgical dissection.

Computer assisted navigation (CAN) provide MIS surgeons with guidance while placing instrumentation and also for non-instrumented cases. It is used for localization as well as for adequacy of decompression in addition to instrumentation accuracy. The use of navigation allows for removing traditional fluoroscopy from the operating room. Navigation systems rely on a reference frame followed by cross sectional imaging to develop an interactive image of a patient’s anatomy. These navigation systems allow for real-time image guidance while reducing intra-operative radiation exposure. Utilization of navigation has been shown to improve accuracy of placement of pedicle screws as well.

Technological advances in spine surgery have been immense, with changes in: operative technique, approaches, biologics, implants, and imaging. With the complexity of the three-dimensional anatomy of the spine and the sensitive nature of the neurovascular structures involved, innovation has optimized safety and efficiency during spine surgery. One change within surgical treatment of the spine was the onset of widespread use of Computer Assisted Navigation (CAN), or colloquially referred to as navigation, in an effort to maximize efficiency and limit complications associated with surgical trauma. To combat the relative inaccuracy of traditional methods of pedicle screw placement and the high stakes of screw misplacement, CAN was introduced as a means to improve accuracy. As minimally invasive spine (MIS) surgery became more prevalent, CAN was used to limit radiation exposure to both the surgeon and patient. The current demands of spine surgery make the use of navigation something that must be considered given the potential to improve accuracy. Current advances in imaging technology and accuracy have made the use of computer assisted navigation (CAN) more prevalent.

What are the advantages of performing a Minimally Invasive Spine Surgery with Computer Assisted Navigation (CAN)?

The advantages are truly numerous. The most important ones are the following:

1. Blood loss is minimized and no transfusion is needed.
2. Surgical time, hospital stay and post-operative recovery time are significantly reduced.
3. The radiation received by the patient during the surgery is minimized.
4. The possibility of postoperative infection and complications from the surgical trauma is minimized.
5. Particularly in oncology patients, rapid recovery helps ensure that their oncology (cancer) treatment is not delayed.
6. The rate of re-operations due to incorrect placement of the materials is dramatically reduced.