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- •Preface
- •Contents
- •Contributors
- •Navigation Using Intraoperative Imaging
- •Fan-Beam CT Navigation
- •Cone-Beam CT Navigation
- •3D Image-Based Computer-Assisted Navigation
- •Robotic Assisted Navigation (RAN)
- •Summary
- •Introduction
- •Navigation Using Preoperative Imaging
- •Light-Based Surface Navigation
- •Conclusion
- •References
- •Intraoperative CT-Based Navigation Systems
- •Fluoroscopy-Based Navigation Systems
- •Machine Vision-Based Navigation Systems
- •Patient Positioning
- •Supine Positioning
- •Prone Positioning
- •Lateral Positioning
- •Cutaneous Arrays
- •Percutaneous Arrays
- •Spinous Process Clamps
- •Static Arrays
- •References
- •Introduction
- •Navigation-Guided Thoracolumbar Instrumentation Techniques
- •SeaSpine 7D Surgical Flash Navigation Process
- •Remaining Steps Are Similar Between Both Systems
- •Minimally Invasive Instrumentation Technique
- •Navigation-Guided Cervicothoracic Instrumentation Techniques
- •Navigation-Guided Spinopelvic Fixation Techniques
- •Conclusion
- •References
- •Introduction
- •Mapping
- •Sacroiliac Joint Fusion
- •Direct Pars Repair
- •Infection
- •En Bloc Tumor Resection
- •References
- •Fluoroscopic-Guided Navigation Systems
- •Computerized Tomography-Guided Systems
- •Robotic Assisted Navigation Systems
- •Augmented Reality-Based Navigation Technology
- •Light-Based Navigation
- •Conclusion
- •References
- •Summary
- •References
- •Introduction
- •Floor-Mounted System
- •Table-Mounted System
- •Summary
- •References
- •Introduction
- •Pre-operative Planning
- •Imaging
- •Intraoperative Planning
- •Patient Positioning
- •Robot Positioning
- •Intraoperatively
- •Robotic Registration
- •Summary
- •Future Developments
- •References
- •Introduction
- •Technique
- •Platforms
- •Cannulation
- •Fixation
- •Summary
- •References
- •Introduction
- •Robotic-Assisted Transforaminal Lumbar Interbody Fusion
- •Robotic-Assisted Anterior Lumbar Interbody Fusion
- •Robotic-Assisted Minimally Invasive Decompression
- •Conclusions
- •References
- •Introduction
- •Pedicle Screw Accuracy
- •Surgical Time
- •Robot-Assisted Navigation Versus Robotics Without Navigation
- •Cortical Bone Trajectory
- •Lateral Positioning
- •Cervical Spine
- •Sacroiliac Joint Fixation
- •Summary
- •References
- •Additive Versus Subtractive Manufacturing Techniques
- •Current Applications
- •Disadvantages
- •References
- •Conclusion
- •References
- •Planning
- •Instrumentation
- •Working Cranially
- •Working Caudally
- •Pelvic Fixation
- •Improved Surgical Precision
- •Adult Spinal Deformity
- •Adolescent Idiopathic Scoliosis
- •Versus Computer Assisted Navigation
- •Cortical Screw Trajectory
- •Cervical Pedicle Screws
- •Atlantoaxial Fixation
- •Miscellaneous Applications
- •Cost-Effectiveness
- •Conclusion
- •References
- •Introduction
- •The Current Market
- •Conclusion
- •References
- •Introduction
- •Legal Theory
- •Informed Consent
- •Robotic or Navigation Technology Error
- •Robotic Use Error
- •Summary
- •References
- •Introduction
- •Nonradiation Real-Time Imaging
- •Conclusion
- •References
- •Index

Navigation, Robotics
and 3D Printing in
Spine Surgery
Current and Emerging
Techniques
SumeetGarg
ChristopherJ.Kleck
Editors
123

Navigation, Robotics and 3D Printing in Spine
Surgery

Sumeet Garg • Christopher J. Kleck
Editors
Navigation, Robotics and 3D
Printing in Spine Surgery
Current andEmerging Techniques

Editors
Sumeet Garg
Division of Orthopedics
University of Colorado
Aurora, CO, USA
Christopher J. Kleck
Spine Center
University of Colorado Health
Aurora, CO, USA
ISBN 978-3-031-68677-1 ISBN 978-3-031-68678-8 (eBook)
https://doi.org/10.1007/978-3-031-68678-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

Preface
We are pleased to present the rst edition of Navigation, Robotics and 3D Printing
in Spine Surgery. This edition was developed after the editors’ presented workshops
on enabling technologies in spine surgery at several international society meetings
and courses beginning in 2020. The pace of adoption of enabling technologies by
spine surgeons has accelerated since 2020in tandem with an increased variety of
offerings of enabling technologies. Ten years ago, most spine navigation was done
with radiography-based imaging utilizing preoperative or intraoperative CT or 3D
uoroscopy. Now there are options involving use of optical technology, increased
use of robotic assistance, and high-resolution 3D printing.
This textbook is designed for the practicing spine surgeon as well as orthopedic
and neurosurgical residents and fellows as an overview of contemporary enabling
technologies for spine surgery. It is divided into three primary sections for each of
the main modern enabling technologies for spine surgery: Image Based Navigation,
Robotic Navigation, and 3D-Printed Patient-Specic Guides. Each section will
review the underlying principles of the technology followed by practical guidance
on application of the technology in surgery and ending with a summary of published
clinical results using the technology. The book will end with a discussion of the
future of navigation in spine surgery.
We encourage you to reach out to us with your comments and suggestions for
future editions of this book. The authors of this book span the breadth of the United
States and treat the most challenging spine deformities in children and adults. We
are proud to share their expertise with our readers. We thank the authors for preparing thoughtful chapters to share their expertise and improve spine care for our audience. Thanks also to the team at Springer Nature and our production editor
Nishanthini Vetrivel for herding a busy group of spine surgeons along over the past
2 years. We hope this textbook serves to aid your journey in improving safety and
quality of spine surgery.
Aurora, CO, USA SumeetGarg
Aurora, CO, USA ChristopherJ.Kleck
v

Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Sumeet Garg
Part I Image Based Navigation
2 Image-Based Spinal Navigation: Current Technology and Future
Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
K. Aaron Shaw, Michael O’Sullivan, and Jaysson T. Brooks
3 Image-Based Navigation: Room and Patient Positioning,
Reference Frame Types and Application . . . . . . . . . . . . . . . . . . . . . . . 17
Felicity Fisk and Nolan Wessell
4 Image-Based Navigation: Instrumentation . . . . . . . . . . . . . . . . . . . . . 29
Ali S. Farooqi, Sachin Gupta, Stuart L. Mitchell, and Jason B. Anari
5 Imaging-Based Navigation: Applications Beyond Instrumentation . . 47
Keemia Soraya Heidari and Christopher J. Kleck
6 Imaging-Based Navigation: Summary of Clinical Results . . . . . . . . . 73
John Whitaker and David Ou-Yang
Part II Robotic Navigation
7 History of Robotics in Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Alex C. DiBartola and Dennis P. Devito
8 Robotic Navigation: Mounting Systems . . . . . . . . . . . . . . . . . . . . . . . . 103
Craig M. Birch and Daniel Hedequist
9 Robotic Navigation: Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Mariano Garay and Mark A. Erickson
vii

viii
Contents
10 Robotic Navigation: Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Theresa J. C. Pazionis, James Suk, and Jeffrey L. Gum
11 Robotic Navigation: Applications Beyond Instrumentation . . . . . . . . 145
Matthew E. Simhon, Gerard F. Marciano, Nathan J. Lee, Michael
W. Fields, and Ronald A. Lehman
12 Robotic Navigation: Summary of Clinical Results . . . . . . . . . . . . . . . 159
Gerard F. Marciano, Matthew E. Simhon, Nathan J. Lee, and
Ronald A. Lehman
Part III 3D Printed Patient Specic Guides
13 3D-Printed Patient-Specific Guides: Basics and Current Systems. . . 179
Seongho Jeong, Meera M. Dhodapkar, Ally Yang, Ali Elaydi,
Taikhoom Dahodwala, and Dominick Tuason
14 3D-Printed Patient-Specific Guides: Planning and
Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Christina K. Hardesty
15 3D-Printed Patient-Specific Guides: Summary of Clinical
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Devon LeFever, Aiyush Bansal, and Rajiv Sethi
Part IV Additional Navigation Considerations
16 Economic Considerations for Navigation in Spine Surgery . . . . . . . . 217
Jessica H. Heyer, Jason B. Anari, and John (Jack) M. Flynn
17 Robotic Navigation: Legal Considerations . . . . . . . . . . . . . . . . . . . . . . 227
Theresa J. C. Pazionis and Jeffrey L. Gum
18 Future Directions for Navigation in Spine Surgery . . . . . . . . . . . . . . . 233
Nicholas A. Felan and Evalina Burger
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Contributors
Jason B. Anari Department of Orthopaedic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
AiyushBansal Department of Neurosurgery, Center for Neuroscience and Spine,
Virginia Mason Medical Center, Seattle, WA, USA
CraigM.Birch Department of Orthopaedic Surgery, Boston Children’s Hospital,
Boston, MA, USA
JayssonT.Brooks Scottish Rite for Children/UT-Southwestern, Dallas, TX, USA
EvalinaBurger Department of Orthopedics, School of Medicine, University of
Colorado Anschutz Medical Campus, Aurora, CO, USA
Taikhoom Dahodwala Yale University School of Medicine Department of
Orthopaedics and Rehabilitation, New Haven, CT, USA
Dennis P. Devito Department of Orthopaedic Surgery, Children’s Healthcare of
Atlanta, Atlanta, GA, USA
Meera M. Dhodapkar Yale University School of Medicine Department of
Orthopaedics and Rehabilitation, New Haven, CT, USA
Alex C. DiBartola Department of Orthopaedic Surgery, Nationwide Children’s
Hospital, Columbus, OH, USA
AliElaydi Yale University School of Medicine Department of Orthopaedics and
Rehabilitation, New Haven, CT, USA
Mark A. Erickson Department of Orthopedic Surgery, University of Colorado
School of Medicine, Aurora, CO, USA
AliS.Farooqi Department of Orthopaedic Surgery, University of Pennsylvania,
Philadelphia, PA, USA
NicholasA.Felan University of Colorado School of Medicine, Aurora, CO, USA
ix

x
Contributors
Michael W. Fields Columbia University Medical Center, Department of
Orthopedics, New York, NY, USA
Felicity Fisk Department of Orthopaedic Surgery, West Virginia University,
Morgantown, WV, USA
John(Jack)M.Flynn Department of Orthopaedic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
Mariano Garay Orthopedic Surgery, Penn State Children’s Hospital,
Hershey, PA, USA
Sumeet Garg Department of Orthopedics, Children’s Hospital Colorado,
University of Colorado, Aurora, CO, USA
JeffreyL.Gum Norton Leatherman Spine Center, Louisville, KY, USA
Sachin Gupta Department of Orthopaedic Surgery, University of Pennsylvania,
Philadelphia, PA, USA
Christina K. Hardesty Orthopaedic Surgery, Rainbow Babies and Children’s
Hospitals, Case Western Reserve University, Cleveland, OH, USA
Daniel Hedequist Department of Orthopaedic Surgery, Boston Children’s
Hospital, Boston, MA, USA
Keemia Soraya Heidari University of Colorado School of Medicine,
Aurora, CO, USA
JessicaH.Heyer Pediatric Orthopaedic Surgery Department, Hospital for Special
Surgery, New York, NY, USA
SeonghoJeong Yale University School of Medicine Department of Orthopaedics
and Rehabilitation, New Haven, CT, USA
ChristopherJ.Kleck University of Colorado School of Medicine, Aurora, CO, USA
NathanJ.Lee Columbia University Medical Center, Department of Orthopedics,
New York, NY, USA
DevonLeFever Department of Neurosurgery, Center for Neuroscience and Spine,
Virginia Mason Medical Center, Seattle, WA, USA
Ronald A. Lehman The Daniel and Jane Och Spine Hospital at New York-
Presbyterian/Allen, New York, NY, USA
Gerard F. Marciano Columbia University Medical Center, Department of
Orthopedics, New York, NY, USA
Stuart L. Mitchell Department of Orthopaedic Surgery, University of North
Carolina School of Medicine, Chapel Hill, NC, USA

Contributors
xi
Michael O’Sullivan Children’s University Hospital, Children’s Health Ireland,
Dublin, Ireland
DavidOu-Yang Division of Spine Surgery, Department of Orthopedic Surgery,
School of Medicine, University of Colorado, Boulder, CO, USA
Theresa J. C. Pazionis Temple University Hospital, Lewis Katz School of
Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
Rajiv Sethi Department of Neurosurgery, Center for Neuroscience and Spine,
Virginia Mason Medical Center, Seattle, WA, USA
School of Medicine,University of Washington, Seattle, WA, USA
K. Aaron Shaw Children’s Mercy Kansas City/University of Missouri Kansas
City, Kansas City, MO, USA
Matthew E. Simhon Columbia University Medical Center, Department of
Orthopedics, New York, NY, USA
James Suk Temple University Hospital, Lewis Katz School of Medicine, Fox
Chase Cancer Center, Philadelphia, PA, USA
DominickTuason Yale University School of Medicine Department of Orthopaedics
and Rehabilitation, New Haven, CT, USA
Nolan Wessell Department of Orthopaedic Surgery, University of Colorado,
Aurora, CO, USA
John Whitaker Division of Spine Surgery, Department of Orthopedic Surgery,
School of Medicine, University of Colorado, Boulder, CO, USA
AllyYang Yale University School of Medicine Department of Orthopaedics and
Rehabilitation, New Haven, CT, USA
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