Robotic and Image-Guided Surgery in the Cervical Spine

Spinal fixation is an integral component of a surgeon’s arsenal to address the multitude of pathologies affecting patients’ spines. Fusion techniques were introduced in free-hand style, with high complication rates. The introduction of fluoroscopic and CTimage guidance systems has greatly reduced this complication rate. More recently, robotic systems are emerging to further increase the safety and efficacy of hardware placement. These technologies are especially important in the cervical spine, as the smaller bony structures and close relationship of neurovascular structures significantly increase the risk of instrumentation relative to the thoracic and lumbar spines. Below we provide an overview of image guidance and robotics in cervical spine surgery, including a discussion of their historical beginnings, advancements over time, and current status. In addition, we review the strengths and drawbacks of current image guidance and robotics technology, and in turn, their future directions.