Stereotactic Navigation in Complex Spinal Surgery: Tips and Tricks

Stereotactic navigation has become an indispensible tool for accurately inserting spinal instrumentation and localizing hidden anatomy. The first-generation navigation systems used slow, and relatively inaccurate methods to synchronize (register) the surgical anatomy with computed tomography images obtained preoperatively. Newer systems overcome these limitations by using 3-dimensional images obtained intraoperatively to register the workstation. They also employ robust software to display the anatomy in orthogonal planes with superimposed images of surgical instruments. These innovations have dramatically improved the effectiveness of stereotactic navigation and allowed image guidance to be a routine and nearly seamless adjunct to spine surgery. The purpose of this article is to provide a brief overview of stereotactic navigation in spine surgery, describe our methods for registration and direct referencing and share lessons learned for best practice use of this promising technology.