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The author discusses the principles and role of frameless image-guided surgery in operative treatment of brain and spine. Short overview of the method is presented in a way comprehensible for medical professionals from outside neurosurgical and orthopaedic fields. The author presents the importance of image-guided technologies in development of minimally invasive and less destructive surgery of brain and spine.

The authors present their experience in the minimally invasive posterior keyhole lumbar corpectomy with transpedicular stabilization. This technique involves the removal of the posterior part of the affected vertebral body with the pedicle screw fixation through four 2-3 cm long skin incisions on the back. Two cephalad skin incisions provide an approach for corpectomy and instrumentation of the upper pedicles of the construct. Two caudal skin incisions provide an approach for instrumentation of the lower pedicles of the construct. The minimum armamentarium requirement includes classic micro lumbar discectomy retractor set and intraoperative fluoroscopy. According to the authors' best knowledge this is the first minimally invasive posterior keyhole lumbar corpectomy ever reported in the literature (2002). This is also the first minimally invasive transpedicular fixation ever performed in Poland (2002). This technique was presented during EANS Congress (Lisbon, September 2003). Some reports have recently appeared in the literature on percutaneous pedicle screw fixation of the lumbar spine in non traumatic cases. A special instrumentarium system (Sextant by Medtronic) has been developed and used in this type of minimally invasive stabilization. Although this system has not been dedicated for spine fractures it is feasible in trauma cases. We have one case of L2 burst fracture fixed percutaneously with Sextant.

Developmental abnormalities or inflammatory disorders provoke deformations and instability of the craniocervical junction. The most dangerous results of these lesions are: sudden brainstem compression or cervical myelopathy. The authors propose the guidelines for surgical management of non-traumatic deformities caused by: a) rheumatoid arthritis of the spine, b) congenital anatomic changes of the occipit and odontoid. Main goals of surgical treatment are decompression and stabilization. The choice of surgical approach and method depends on pathology. It is very important to estimate individual anatomic changes and mobility--possibility of reduction. The authors discuss surgical methods actually used for fusion and decompression of the occipitocervical junction.