Spinal navigation: an accepted standard of care?

Objective: In contrast to cranial neuro-navigation, which has been accepted as a routine intraoperative tool, there is still much debate about spinal navigation as an aid for the insertion of pedicle screws. Opinions range from "not useful at all" to "malpractice if not using it". The aim of our investigation was to obtain data about the availability of spinal navigation and compile a common opinion among German neurosurgeons about its usefulness. The current literature is reviewed.

Methods: We present the results of a survey of the Commission for Technical Standards of the German Neurosurgical Society about the use of intraoperative computerised spinal navigation.

Results: Of the 128 neurosurgical departments surveyed, 107 (84 %) responded. 57 (53 %) of the responders are equipped with a spinal navigation device, 12 (11 %) use a spinal navigation equipment together with other departments, and 38 (36 %) do not have spinal navigation. Of the departments not equipped with spinal navigation, 58 % would like to have it but 42 % would not. 52 (49 %) responders held the opinion that spinal navigation enhances safety when introducing pedicle screws; while 40 (37 %) answered in the negative, and 15 (14 %) were not sure. Of the responders, 101 (94 %) disagreed with the statement that spinal navigation should be mandatory for pedicle screw placement, 3 (3 %) agreed, and 3 (3 %) were not sure. Of the responders, 105 (98 %) rejected the statement that insertion of pedicle screws without navigation is medical malpractice, 1 (1 %) upheld the statement, and 1 (1 %) was not sure.

Conclusion: It is still not generally considered common practice to use spinal navigation as an aid for the implantation of pedicle screws. Most pedicle screws are still inserted conventionally. Although nearly 50 % of German neurosurgeons believe that spinal navigation could enhance safety when placing pedicle screws, they clearly reject efforts to make spinal navigation mandatory. With only one exception, the German neurosurgical community unanimously rejects the idea that placing pedicle screws without spinal navigation is medical malpractice.