Making Spine Surgery Safer & More Precise

Image-guided navigation and robotics are emerging technologies that help surgeons in many fields perform procedures more safely and precisely than ever before with less invasive techniques.

Originally introduced in the 2000s, intraoperative navigation combines imaging with 3-D systems of orientation to facilitate accuracy and precise anatomic knowledge during surgery.

ION in spine surgery continues to grow in popularity as more surgeons are trained on the platforms and become familiar with its benefits, particularly accuracy and patient safety. ION is used in thoracic, lumbar, and upper cervical spine, as well as skull-base surgeries.

“It is particularly useful in spinal surgery,” says Dr. James Patrick Lawrence, orthopedic spine surgeon at the MUSC Health Spine Center. “The precision of ION lends itself naturally to spinal surgery because the anatomy in spine surgery is quite small, and acting with precision down to millimeters is critically important. ION enhances accuracy and patient safety,” says Dr. Lawrence, who is also a professor of orthopedic surgery in MUSC’s Department of Orthopedic and Physical Medicine and has written numerous articles and book chapters on spine surgery.

In some cases, ION and robotics can be used in tandem to optimize outcomes. MUSC Health’s spine center is the only one in the region that combines ION and robotics for spine surgery.

Dr. Lawrence utilizes ION for elementary elective procedures, as well as the more complex procedures or abnormalities in patient anatomy.

“ION is invaluable in patients who have had trauma, tumors, spinal deformities or patients who’ve had previous surgeries,” he says. “These variations can be difficult to precisely appreciate in the absence of ION. Navigation and robotics are game-changing technologies that allow us to provide surgery better and more safely than ever before.”

In addition to providing greater accuracy and precision, ION increases patient safety and allows for less invasive surgical approaches. It reduces blood loss and the risk of infections or complications due to soft tissue injuries and is also an invaluable teaching tool in MUSC resident education and training, Dr. Lawrence says.

“The most important benefit is patient safety,” Dr. Lawrence says. “Specifically, ION allows surgeons to work with greater accuracy than with historical methods that use fluoroscopy or the freehand technique that relies on visible anatomic landmarks.”

During an ION procedure, the surgical team places a fixed point or a reference array on part of the patient’s anatomy, such as the pelvis or the spine. Instruments are registered with the navigation system and their positions are tracked using CT imaging. The system provides real-time patient data and visualization of the position and orientation of surgical instruments in relation to the patient's spine.

In contrast, the use of the robot relies on presurgical imaging, which allows surgeons to have a precise, visual presurgical plan for surgery, including instrumentation, or the implants that may be placed during surgery. In robotics, doctors can use the imaging performed prior to surgery to precisely prepare beforehand all the instrumentation that will be used, as well as the sequence of procedural steps during surgery. The robot then serves as an accuracy aid and, in minimally invasive surgical techniques (MIS) the robot also allows for small incisions with maximum precision. 

Dr. Lawrence, who has used ION and robotics for over 10 years, says that although ION systems have a significant learning curve, they also have an elegant simplicity that allows surgeons to incorporate the technology easily into their practice.

“ION has radically advanced and changed the practice of spine surgery in a very positive way,” he says. “It fosters innovation and novel thinking, and its use will only increase in the future. Navigation and robotics are how we learn and grow toward doing surgery differently and better, that is faster, less invasive and reduces blood loss and risk of complications for patients,” he says.

Still, he reminds patients that certain technological advances, particularly the use of robotics, can be misunderstood by the public. “Everything remains under the controls of the mind and hands of the surgeon. It is a tool, not an independent device, and certainly not an artificial intelligence platform. At MUSC Health, where patients come from all over the southeast for spine surgery, our usage of robotics and navigation highlights our commitment to providing superb, safe, and modern patient care.”