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Spine Home PageComputer Assisted Surgery for the Spine

Computer assisted surgery (CAS) is cutting-edge medical technology that was first developed for neurosurgery, where surgical precision in and around the critical structures of the brain is of the utmost importance.  CAS instrumentation and techniques continue to evolve, and its use in spine surgery is rapidly on the rise.  It provides spine surgeons the ability to operate with better visualization and more accuracy than ever before.
Spine surgeons may use computer assisted surgery to help place implants (such as pedicle screws) during spinal fusion procedures to treat spinal instability caused by degenerative disc disease, deformity, spinal stenosis, spondylolisthesis, fractures, tumors and infection.
The main premise behind CAS is specialized software creates a virtual, 3-D model of the patient’s spine, essentially a digital roadmap or blueprint to help guide the surgeon.  During spine surgery, the surgeon matches the patient’s actual spine to the computer’s virtual model displayed on the monitor in the operating room.  Much like a GPS system in an automobile, the surgeon is then able to track in real time the position of surgical instruments and implants in relation to the patient’s true anatomy.  For this reason, CAS may also be referred to as surgical navigation.
Stryker’s CAS technology for spine surgery consists of 1.) an infrared navigation camera, 2.) Smart Instruments with light-emitting diode (LED) technology and 3.) a computer with specialized surgical navigation software.
Prior to surgery, the patient undergoes a CT scan, and these images are downloaded in to the navigation computer.  The software uses these images to build the virtual, 3-D model of the spine.  In a process called registration, the surgeon uses Smart Instruments to match pre-defined points on the 3-D computer model to the patient’s true anatomy.  The software uses these points to correlate the position of the patient in real-time with the computer generated 3-D model to create a digital map of the spine.
Rather than sending the patient for a pre-operative CT scan, some surgeons may utilize a 3-D intraoperative imaging device to obtain the images and automatically register the patient’s anatomy in the operating room.
Once registration is complete, the navigation camera tracks the movement and position of Smart Instruments in the surgical field and real-time images of the instruments are displayed on the 3-D model.  The surgeon is then able to see the exact position of the instruments, aiding in surgical precision and helping to avoid potential damage to surrounding tissue and structures (such as the spinal cord, nerves and arteries).  In spinal fusions, the surgeon may also use the 3-D model to plan the position, length and diameter of pedicle screws, and then navigate instruments to ensure the screws are implanted exactly as planned.
Surgical navigation does not replace the skill of the surgeon.  This technology provides the surgeon with real-time guidance in placing implants in the spine where visibility with the human eye may be challenging.  Dr. Charles Haworth, spine surgeon and Clinical Assistant Professor of Neurosurgery at Duke University, describes how CAS assists him to more precisely place pedicle screws. “It’s like diving a nail down a pencil, without breaking the pencil. It’s that easy using navigation.”
There are several benefits CAS offers both the surgeon and the patient.  During conventional spine surgery without the use of surgical navigation, surgeons may take multiple X-ray images to verify the location of instruments and placement of implants throughout the procedure.  CAS eliminates the need for repetitive X-ray images, helping to reduce radiation exposure to both the patient and medical team.[1]
It provides the surgeon with comprehensive data about the patient’s anatomy to pre-plan for surgery and determine such things as pedicle screw length, diameter and position; potentially saving valuable time and uncertainty in the operating room.  In addition to having a computer model of the patient’s spine to reference during surgery, CAS delivers real-time guidance of the positioning of instruments and implants along with the ability to correct potential implant misplacement during surgery.
Additionally, CAS enables minimally invasive procedures by offering the surgeon enhanced visualization of the anatomy, especially when smaller incisions are used.[2]
If you are reading this, chances are you or someone you know is considering spine surgery.  Be sure to talk to your doctor about the type of treatment options available and what is best for you.  As with any surgery, computer assisted spine surgery has certain risks.  Talk to your doctor about the type of surgery appropriate for you and the associated risks. Click to find a surgeon near you.

Common Conditions & Treatment

CAS technology may be used to help implant pedicle screws during spinal fusion procedures to treat spinal instability caused by the following conditions.[3] Read more.

Surgeon Testimonials


I started getting involved with navigation about 12 years ago because I was primarily interested in the accuracy of the procedure.  I wanted to place my pedicle screws accurately in the spine to try to avoid nerve injury."

Dr. Charles Haworth
Clinical Assistant Professor of Neurosurgery
Duke University

Video Resources

Image Gallery

SpineMap 3D NavigationComputer assisted spine surgery provides surgeons with real-time feedback of the exact location of instruments and pedicle screws in relation to the patient’s spine and critical anatomy. Specialized software displays the exact path the pedicle screw is taking.

Cervical ShotCAS software has planning features that enable surgeons to segment out specific anatomy. This offers spine surgeons enhanced visualization of the spine and provides aided confidence when operating close to delicate structures (such as nerves, blood vessels and spinal cord).

Phong Volume RenderingCAS software offers surgeons the ability to plan the position, length and diameter of pedicle screws on a 3-D model of the patient’s spine prior to a spinal fusion procedure. In the operating room, the surgeons navigate their instruments, using this model as a guide, to ensure the pedicle screws are implanted according to the plan.

(Spine) Spine Nav Intraoperative GuidanceDr. William Choi, spine surgeon at Sky Ridge Medical Center, Lone Tree, CO, navigates a Smart Instrument while inserting a pedicle screw during a spinal fusion surgery. Surgical navigation software provides surgeons with real-time information about the exact position of instruments and implants in relation to the patient’s spine.

DrSaadiSmartInstrumentDr. Paul Saadi, orthopaedic surgeon, Dallas Bone and Joint Clinic, Dallas, TX, uses a Smart Instrument to help implant a pedicle screw during a spinal fusion surgery. Computer assisted surgery offers surgeons real-time guidance on the position of their instruments to assist in the optimum placement of spine implants.


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