Spinal News International Interviews Dr. McConnell
Dr. Jeffrey McConnell was recently asked his thoughts on intraoperative fluoroscopic navigation during an opinion interview with Spinal News International. Read his opinion on why this relatively new technology has not been as popular as expected for spinal surgeons from around the world.
Whilst intraoperative fluoroscopic navigation may offer a number of benefits to spinal surgery, uptake in the field is still relatively low. Jeff McConnell talks to Spinal News International about the limits of this technology.
What can intraoperative fluoroscopic navigation enable physicians to achieve?
There is an important difference, here, between fluoroscopic imaging and fluoroscopic navigation. I use fluoroscopic imaging frequently to localise bony anatomy to assist in placing pedicle screws percutaneously in the spine. It is truly “real-time” imaging. A disadvantage is that the images obtained are two-dimensional. Capturing these images also leads to radiation exposure. Fluoroscopic navigation can be done in different ways, all based on obtaining anteroposterior and lateral fluoroscopic images using an aftermarket reference frame attached to the C-arm. The images are then correlated using computer software with a pre-operative computed tomography (CT) scan. The simplest software system that I have seen simply requires the surgeon to plot screw direction with triangulation, and then line up the starting point on the skin with fluoroscopy. As long as you maintain the proper angle of trajectory, then placement should be successful. This can be fiddly, and it takes time to plot each screw. This seems less accurate to me.