Fluoroscopy and Spinal Navigation

Standard fluoroscopy is familiar to most spine surgeons because it provides real-time intraoperative visualization of spinal anatomy. The major limitations of fluoroscopy are occupational radiation exposure and the fact that the images can only be obtained in one plane at a time. Image-guided spinal navigation has evolved as a spinal surgical tool overcoming the limitations of standard fluoroscopy. It has been proven to be a versatile and effective tool for facilitating complex surgical procedures. However, image guidance has its limitations and does not replace the surgeon’s own experience and judgment. There are several modalities of spinal image guidance (such as CT-based, fluoroscopy-based, three-dimensional C-arm fluoroscopy), and each has its own advantages and limitations. Pitfalls and errors are related to issues of the accuracy, technique, and overall ease of use of the technology during surgery. A thorough understanding of these problems is required to ensure an effective use of image-guided navigation for spinal surgery.