Navigation and Robotic-Assisted Spine Surgery

Navigation and Robotic-Assisted Spine Surgery

Daniel J. Hedequist


  • Workstation

  • Navigation system to include instruments and display panel

Three-Dimensional Imaging System

  • Institutional preference O-arm (Medtronic)

  • Compatible with robotic/navigation system


  • Preoperative computed tomography (CT) scan with dosing protocol for pediatric patients as well as dosing compatibility with computer software

  • Alternative is to obtain intraoperative three-dimensional scanning (O-arm or equivalent/compatible)


  • Prone positioning for standard spine deformity surgery. Need to assure for three-dimensional imaging such as O-arm that the appropriate area of the spine can be scanned. For example, for imaging the proximal spine, the O-arm may not be able to circumferentially fit around the table with the arm boards in standard position

    • Cervical spine: Arms down at side and taped down in secure position

    • Standard spine: Arms taped down or placed in “superman” position (Figure 4.1)

  • Navigation cameras and screens should be set up to optimize surgical efficiency and visualization

  • Cameras should be placed in order to have a direct line of sight with the reference frames and instrument arrays placed in surgical fields

  • Navigation screens should be placed in optimal positions for efficient and ergonomic techniques (Figures 4.2 and 4.3)


  • Standard posterior subperiosteal exposure of spine over area of interest

  • Different workflows exist with regard to when facetectomies or osteotomies are done, as these may cause excess spine motion, which affects accuracy of registration. In general, 2 options exist:

    • Once the region is scanned and registered, then navigated burring of the starting point and drilling of the appropriate screw path is done, followed by placing FloSeal and moving to the next level. Screws are then placed after the surgeon does facetectomies/osteotomies

    • Performing facetectomies prior to scanning and then moving forward with registration and then placement of screws with navigation. This allows for more direct visualization of anatomy and starting points as would be done with free-hand screw placement (Figure 4.4)

Navigation Surgical Technique

Jun 9, 2022 | Posted by in Reconstructive surgery | Comments Off on Navigation and Robotic-Assisted Spine Surgery

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