Spine Surgery pp 129-137 | Cite as

Navigation of the Cervical, Thoracic and Lumbar Spine

  • Hanno S. Meyer
  • Yu-Mi RyangEmail author


Computer-assisted navigation (CAN) is a widely employed tool in spinal instrumentation surgery. It permits high-quality image guided placement of pedicle screws based on registration of preoperative or intraoperative spinal imaging data (e.g., preoperative or intraoperative CT images, intraoperative 3D fluoroscopy). The surgeon is thus provided with visual feedback showing the current planned screw placement trajectory superimposed on the imaging data of the patient. This is supposed to improve the safety and accuracy of pedicle screw placement and thus reduce complications potentially associated with screw misplacement, such as instability, neurological injury or revision surgery.


  1. 1.
    Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: where are we now? Neurosurgery. 2017;80:S86–99.CrossRefGoogle Scholar
  2. 2.
    Fichtner J, Hofmann N, Rienmüller A, Buchmann N, Gempt J, Kirschke JS, Ringel F, Meyer B, Ryang YM. Revision rate of misplaced pedicle screws of the thoracolumbar spine – Comparison of three-dimensional fluoroscopy navigation with freehand placement: a systematic analysis and review of the literature. World Neurosurg. 2018;109:e24–32.CrossRefGoogle Scholar
  3. 3.
    Zhang W, Takigawa T, Wu YG, Sugimoto Y, Tanaka M, Ozaki T. Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques. Eur Spine J. 2017;26:1756–64.CrossRefGoogle Scholar
  4. 4.
    Verma R, Krishan S, Haendlmayer K, Mohsen A. Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J. 2010;19:370–5.CrossRefGoogle Scholar
  5. 5.
    Kim YJ, Lenke LG, Bridwell KH, Cho YSS, Riew KD. Free hand pedicle screw placement in the thoracic spine: Is it safe? Spine (Phila Pa 1976). 2004;29:333–42.CrossRefGoogle Scholar
  6. 6.
    Shin BJ, James AR, Njoku IU, Hartl R. Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. A review. J Neurosurg Spine. 2012;17:113–22.CrossRefGoogle Scholar
  7. 7.
    Villard J, Ryang YM, Demetriades AK, Reinke A, Behr M, Preuss A, Meyer B, Ringel F. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976). 2014;39:1004–9.CrossRefGoogle Scholar
  8. 8.
    Ryang YM, Villard J, Obermuller T, Friedrich B, Wolf P, Gempt J, Ringel F, Meyer B. Learning curve of 3D fluoroscopy image-guided pedicle screw placement in the thoracolumbar spine. Spine J. 2015;15:467–76.CrossRefGoogle Scholar
  9. 9.
    Meyer B, Ryang YM. Yes, We CAN! World Neurosurg. 2013;79:85–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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