Image-guided endoscopic spine surgery - Part II: Clinical applications

Study Design. Endoscopic spinal procedures were performed under computed-to mography-based, image-guided assistance. Objective. To assess the clinical feasibility of applying a methodology tha t allows image-guided assistance in endoscopic spinal surgery. Summary of Background Data. Endoscopic spinal procedures have become a part of the minimal invasive approaches to the spine. The main disadvantage of these techniques is the long learning curve and the lack of peroperative mo nitoring. Fluoroscopy does have disadvantages, such as positioning during s urgery and the risk for radiation exposure. Fluoroscopy-based navigation ha s many advantages, however it is still based on preselected fluoroscopic im ages. There is no method that allows computed-tomography-based navigation i n endoscopic conditions. Methods. Two patients have been operated on using endoscopic approaches ass isted by computed-tomography-based navigational system. One had a thoracosc opic approach for median calcified disc herniation and another one had an e ndoscopic posterior approach for resection of a sacro-iliac osteophyte. For each patient, a frame of reference had been placed percutaneously and scan ned. The computed tomography images were registered to the anatomy using th e geometry of the frame as fiducials. Navigation through endoscopic approac hes was possible in both cases. Results. In both cases navigation was reliable and a helpful monitoring to achieve the surgical goals through endoscopic approaches. Conclusions. There are some factors that make endoscopic spine surgery a di fficult start. Image-guided spine surgery is technically feasible and clini cally applicable in endoscopic approaches.