Surgical navigation is a technology that helps the surgeon place screws and implants more accurately, like an intraoperative “GPS.” Its greatest value is in complex procedures (deformities, revisions, altered anatomy, or fragile bone), where millimeters matter. It does not eliminate risk 100%, but it can reduce placement errors and improve safety.
- Surgical navigation can improve accuracy when placing pedicle screws and pelvic instrumentation.
- In revision surgeries, it is especially useful because anatomy changes due to scar tissue and previous hardware.
- “Navigation-guided double iliac fixation” aims for stronger anchorage in very demanding surgeries.
- It is not magic: risks still exist, and the team’s experience matters as much as the technology.
- Recovery depends more on the type of surgery than on the use of navigation, but greater accuracy can prevent “avoidable” problems.
Surgical navigation in spine surgery
In high-complexity surgeries, such as revision procedures, using surgical navigation is key.
In this case, navigation-guided double iliac fixation allows millimetric precision, achieving correct implant positioning with maximum safety.
✔️ Greater precision
✔️ Fewer complications
✔️ Better surgical outcomes
Advanced technology serving the patient at Complex Spine Institute.
Now let’s translate that message into “patient language”: what it really means, when it adds value, what its limits are, and which questions are worth asking before deciding.
1) What is surgical navigation in spine surgery?
Surgical navigation is an intraoperative guidance system that helps accurately locate bony structures and plan the trajectory of screws and implants. In simple terms, think of it as a GPS that combines:
- 3D imaging (for example, an intraoperative CT scan or an O-arm-type system).
- Software that reconstructs the anatomy and displays the instrument in real time.
- Tracked instruments using cameras or sensors, so the surgeon can see on screen where the tool is and where it is going.
Its main goal is straightforward: to place implants more precisely when the margin for error is small and nearby structures (nerves, spinal cord, vessels) are delicate.
2) Why can “millimeters” change everything in spine surgery?
In spine surgery, pedicle screws (placed into the vertebral “pedicle”) and other implants are frequently used. The pedicle is a relatively narrow “bony corridor” that sits very close to:
- Nerve roots (pain, tingling, weakness if irritated or injured)
- The spinal cord (especially in upper levels)
- Major blood vessels
That is why precision is not a tech luxury: it is a way to reduce the risk of misplacement, revisions, and mechanical complications.
3) When does it add the most value? (Practical guidance for patients)
Not every surgery requires navigation, but it tends to help most in these situations:
Revision surgery (re-operations)
After a previous operation, anatomy is no longer “textbook”: there may be scar tissue, bone changes, old screws, partial fusions, and sometimes deformity or loss of alignment. In that context, navigation can help orient the surgeon more reliably and place new instrumentation more safely.
Deformities (adult scoliosis, kyphosis, sagittal imbalance)
Deformities involve vertebral rotation and displacement, which makes “eyeballing” landmarks harder. Navigation can improve trajectory planning.
Pelvic (iliac) instrumentation and long constructs
When surgery needs pelvic anchorage to increase stability (for example, long fusions or complex cases), accuracy when placing iliac or S2AI screws becomes especially important.
Fragile bone or challenging anatomy
Osteoporosis, small vertebrae, anatomical variants, or situations where it is safer to “confirm” rather than “estimate.”
Minimally invasive surgery (MIS)
With smaller incisions, less bone is directly visible. Navigation can compensate for that limited view.
4) What is “navigation-guided double iliac fixation” and why is it used?
Iliac instrumentation means placing screws in the iliac bone (pelvis) to create a very solid anchor when the spine needs powerful stabilization, for example in:
- Long fusions (extensive thoracolumbar constructs)
- Revisions for hardware failure or pseudoarthrosis
- Complex deformities
- Severe instability requiring pelvic support
When we talk about double iliac fixation, it typically refers to a more robust pelvic configuration (depending on the case, bilateral screws and/or reinforced pelvic fixation strategies). The reason is biomechanical: the pelvis can act as the “foundation” when the construct is long and subjected to high forces.
What does navigation add here?
- A safer trajectory in a bone with complex geometry.
- Better bone purchase (a well-positioned screw holds better).
- Lower risk of breaching the cortex and getting too close to sensitive structures.
In other words: when the case is demanding, “getting it right the first time” matters more than ever.
5) Expected benefits (without unrealistic promises)
These are reasonable benefits often reported in the literature and in clinical practice, especially in complex surgeries:
More accurate screw placement
Studies compare freehand techniques, conventional fluoroscopy, and navigation (including intraoperative CT). Overall, navigation tends to improve “acceptable” placement rates and reduce screws with significant breach.
Fewer malposition-related complications
A poorly placed screw can cause pain, neurological deficit, reoperation, or mechanical problems. Navigation can reduce part of that risk, although it does not eliminate it.
Better planning in revision cases
In re-operations, it helps make better-informed choices: which route to take, which screws to remove, where the best bone is, and how to avoid difficult scarred areas.
Optimizing the surgical result
“Optimize” does not mean “guarantee success,” but rather reduce avoidable technical factors that could compromise the outcome.
6) Risks and limitations: what you should know before idealizing the technology
Navigation is a powerful tool, but it is not flawless. These are real limitations:
It does not replace experience
A skilled team with the right indication and planning remains the most important factor. Navigation helps, but it cannot compensate for the wrong indication or a poor strategy.
It can increase initial setup time
The patient must be registered, images acquired, and the system calibrated. In experienced hands it integrates well, but there is a learning curve.
Radiation exposure (depending on the system)
Some systems use intraoperative CT, which can increase patient dose compared with simple fluoroscopy. However, it may reduce staff exposure and improve accuracy. The key is using dose protocols and applying the technology thoughtfully.
Registration errors or undetected movement
If the system loses calibration or there is movement that goes unnoticed, it may create a false sense of security. That is why it must be paired with verification and clinical judgment.
Cost and availability
Not every center has the same technology. And even when available, it is not always necessary.
7) Diagnosis and planning: which tests help decide whether navigation makes sense
For navigation to truly help, the surgical indication must be clear first. Typical steps and tests include:
Clinical history and full neurological exam
Pain, functional limitation, radicular symptoms, signs of myelopathy, gait, strength, reflexes, and sensation.
High-quality, goal-oriented imaging
- MRI for nerves, spinal cord, and discs.
- CT to assess bone, previous screws, or detailed planning.
- Dynamic X-rays if instability is suspected.
Define whether it is primary surgery or a revision
In revision cases, navigation usually carries more weight because anatomy is no longer “standard.”
8) Alternatives to navigation (and when they may be enough)
Having navigation available does not mean it is mandatory. Common alternatives include:
Freehand technique using anatomical landmarks
In standard surgeries and experienced hands, it can be appropriate, especially in simpler cases.
Fluoroscopy (C-arm)
Provides real-time X-ray guidance. It is useful, but it does not always offer the same 3D information as CT-based navigation.
Robotic guidance
Robotics is often combined with navigation. In some settings it improves consistency and reduces deviations, but evidence varies by procedure and system.
For patients, the useful question is not “Do you have navigation?”, but: “Does my case benefit from navigation, and why?”
9) Realistic recovery: what changes (and what doesn’t) when navigation is used
Navigation usually does not change recovery time by itself. What matters most is:
- Type of surgery (simple decompression vs long fusion)
- Number of levels
- Preoperative condition (chronic pain, strength, comorbidities)
- Bone quality
- Revision surgery vs primary surgery
What may change indirectly is the chance of technical complications that delay recovery (for example, having to revise a malpositioned screw).
General timelines (very broad)
First days: pain control, safe mobilization, prevention of thrombosis and constipation.
2-6 weeks: gradual improvement, regular walks, start of prescribed rehabilitation.
6-12 weeks: more independence, gradual return to activity depending on the procedure.
3-12 months: full functional recovery and fusion consolidation (in fusion surgeries), with wide variability.
When to seek emergency care
After spine surgery, seek urgent care if you develop:
- New or worsening weakness, difficulty walking, or loss of bowel/bladder control.
- High fever, chills, a red painful wound with drainage.
- Uncontrolled pain that does not respond to prescribed medication.
- Shortness of breath, chest pain, or marked swelling in one leg.
Myths and realities about surgical navigation
Myth: “With navigation there are no complications”
Reality: it helps reduce certain technical complications, but it does not eliminate general risks (infection, bleeding, thrombosis, persistent pain).
Myth: “Navigation is for every surgery”
Reality: it contributes most in complex cases, revisions, deformity, or difficult instrumentation.
Myth: “Without navigation, surgery is unsafe”
Reality: many surgeries are very safe without navigation in experienced hands. Safety depends on indication, team expertise, and overall planning.
Frequently asked questions
Is surgical navigation the same as robotic surgery?
Not exactly. Navigation guides orientation and placement using imaging and software. Robotics often uses navigation to plan and then helps execute the trajectory with mechanical assistance. They can be combined or used separately depending on the system.
Which part of the surgery uses navigation?
Mostly during planning and placement of screws and implants (for example, pedicle screws or iliac instrumentation). It can also help confirm alignment or trajectories in complex surgeries.
Does it mean I will have a smaller incision?
Not necessarily. It can facilitate minimally invasive techniques, but incision size depends on the surgical goal, the deformity, the number of levels, and the chosen strategy.
Is there less pain afterward if navigation is used?
Postoperative pain depends more on the type and magnitude of surgery. Navigation does not “provide pain relief” by itself, but improved accuracy may reduce technical issues that could increase pain or complications.
Does navigation prevent reoperation?
It cannot guarantee that. It may reduce revisions related to screw malposition or other technical errors, but there are many reasons for revision that are unrelated (infection, pseudoarthrosis, degenerative progression, etc.).
Is it especially useful for iliac screws or pelvic fixation?
Yes, it is often one of the scenarios where it makes the most sense, because pelvic anatomy is complex and the goal is to achieve very strong, safe anchorage.
Does it increase radiation?
It depends on the system. Some intraoperative CT-based methods can increase patient dose compared with simple fluoroscopy, but they may also reduce staff exposure and improve accuracy. What matters is thoughtful use and dose protocols.
Glossary
Surgical navigation: image- and software-based intraoperative guidance to improve accuracy when placing implants.
Pedicle screw: a screw placed into the vertebral pedicle to stabilize the spine.
Revision surgery: reoperation after a previous surgery due to hardware failure, pseudoarthrosis, deformity, persistent pain, or other causes.
Iliac instrumentation (pelvic fixation): screws placed in the pelvis to reinforce stability in long or complex fusions.
O-arm/intraoperative CT: 3D imaging systems used during surgery for navigation.
Pseudoarthrosis: lack of bone healing after a fusion (it does not “fuse” as expected).
If you have been offered a complex spine surgery or a revision procedure, requesting a specialist evaluation and a clear explanation of the plan (including whether navigation is useful in your case) can help you decide with greater confidence and more realistic expectations.
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC10710891/
https://www.jmirs.org/article/S1939-8654%2824%2900562-9/abstract
https://www.sciencedirect.com/science/article/pii/S187887502402000X
https://foliamedica.bg/article/149171/
Health education notice: this article is for informational purposes and does not replace an individual medical assessment. If you have neurological symptoms or you have been advised to undergo surgery, consult a specialist.
