gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Spinal navigation using intraoperative 3D imaging: Technique, results, pitfalls and limitations

Spinale Navigation mit intraoperativer 3D Bildgebung: Technik, Erfahrungen, Fallstricke und Grenzen

Meeting Abstract

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  • corresponding author U. Hubbe - Abteilung Allgemeine Neurochirurgie, Wirbelsäulenschwerpunkt, Universitätsklinikum Freiburg im Breisgau
  • V. I. Vougioukas - Abteilung Allgemeine Neurochirurgie, Wirbelsäulenschwerpunkt, Universitätsklinikum Freiburg im Breisgau

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 043

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Hubbe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Since years numerous attempts have been made to establish navigation in spine surgery. However, the available techniques of CT- and fluoroscopy based spinal navigation have not been accepted widely due to constraints mainly concerning the process of patient registration. We present our experience with spinal navigation based on intraoperative acquired 3D-data and automatic patient registration in 110 surgical procedures.

Methods: Spinal navigation was used in 110 patients in the cervical, thoracic and in special cases in the lumbar spine. The system was mainly used for percutaneous stabilisation and vertebro- / kyphoplasty procedures. After acquiring of a 3D dataset using the 3D C-arm system, image data were transferred to the navigation system (Stryker) via network and registered automatically. Therefore, troublesome manual matching and registration procedures were avoided.

Results: After an initial a learning curve and solution of different technical problems, we could establish a robust and effective protocol for spinal navigation. An essential point was, that special diligence had to be taken to the positioning and fixation of the patient tracker. This had great influence on image quality and accuracy of the navigation. Since image acquisition was performed intraoperatively and thus in the same position as surgery, it was possible to use navigation even for multilevel interventions once the patient was registered. In nearly all cases a high accuracy was achieved after automatic registration of the intraoperative image data. Preparation of the navigation system and intraoperative imaging took a mean of 15±6 min. Significant reduction of total operation time was achieved by availability of navigation. For instance, percutaneous transpedicular screw fixation was regularly possible in 50±17 min. Especially the implantation of cervical pedicle screws was optimized, accelerated and simplified through this approach.

Conclusions: Spinal neuronavigation using intraoperative acquired 3D image data has proven to be a beneficial and robust technique providing additional security to minimally invasive spine surgery. A troublesome manual patient registration process can be avoided and a notable intraoperative accuracy can be achieved. Specific difficulties and pitfalls can be eliminated by implementation of a standardized protocol.