Development and Overview of Spinal Navigation: Clinical Aspects

Spinal navigation has evolved from basic fluoroscopy to sophisticated systems that integrate intraoperative three-dimensional (3D) imaging, electromagnetic and optical tracking, robotics, and artificial intelligence (AI). These advances enhance accuracy of instrumentation, reduce radiation exposure for the surgeon and staff, and expand clinical applications beyond screw placement. This chapter reviews the technological evolution of spine surgery navigation, compares 2D fluoroscopy and 3D image-guided methods, examines tracking modalities, discusses robotics and AI integration, and summarizes safety, accuracy, and radiation considerations. It also highlights perioperative uses—such as planning minimally invasive approaches and real-time guidance for decompression and tumor resection—and addresses challenges in surgeon comfort, workflow integration, and institutional adoption. Finally, future directions in AI-driven planning, augmented reality, and vision-based navigation are explored.