title: Image-guided thoracoscopic spinal surgery: a merging of 2 technologies.
abstract: METHODS
  Retrospective clinical and intraoperative navigational data review.
  
  
  OBJECTIVE
  To evaluate quantitatively the application of frameless stereotactic image guidance in thoracoscopic discectomy procedures.
  
  
  BACKGROUND
  Thoracoscopic spinal surgery has technical and anatomic challenges that result in difficult orientation with a 2-dimensional imaging procedure in a complex 3-dimensional structure.
  
  
  METHODS
  There were 16 patients who underwent image-guided thoracoscopic discectomy procedures that combine these 2 technologies. Accuracy was determined by the registration (calculated) error and actual navigation (intraoperative) error. The clinical outcomes and complications were reviewed.
  
  
  RESULTS
  Accuracy determined by registration (calculated) and navigation (intraoperative) was 1.7 and 1.2 mm, respectively. The additional time required for the image guidance portion of the procedure was countered by the efficiency of the remaining procedure. Clinical outcomes and complication were comparable with previous experience.
  
  
  CONCLUSIONS
  Image-guided thoracoscopic spinal surgery can provide 3-dimensional orientation to a 2-dimensional imaging procedure that ultimately improves accuracy, efficiency, and safety. Future developments in combining guidance technology with standard surgical procedures will likely continue.
authors.affiliation: Cedars-Sinai Institute for Spinal Disorders, Los Angeles, CA, USA. johnsonjp@CSHS.org
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
authors.forename: John K
authors.initials: JK
authors.lastname: Stokes
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.forename: William W
authors.initials: WW
authors.lastname: Choi
authors.forename: Wesley A
authors.initials: WA
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D017586:Diskectomy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013906:Thoracoscopy / Q000379:methods / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D014584:User-Computer Interface