Commentary: “The Future of Spinal Cord Stereotaxy: An overview”

Dear Editor,

I read with much interest the publication by Nadvornik[1] on the historical perspective of spinal cord stereotaxy. This is a very subjective nonetheless interesting narrative report about the development of this technology. The first attempts to perform a systematical and guided spatially accurate approach to the spinal cord were reported already in 1874[1] [2] [3] based on anatomical specimen and animal models. Although a system for targeting relying on computerized atlas models and devices which are attached to the spinous processes had been developed mostly in the hands of the author since the 1960s the technology has not found wider acceptance in the stereotactic and functional field. Typical functional spinal cord operations (other than the widespread applied epidural spinal cord stimulation) that are performed today with respect to the treatment of otherwise refractory conditions (pain and spasticity) are for example dorsal root entry zone (DREZ) lesioning[4] and possibly cordotomy. These procedures are safe in the hands of experienced experts and can be performed either under image guidance or in a microsurgical approach.[4] Spinal cord lesions themselves are typically approached micro-neurosurgically. The procedure, that today most closely resembles spinal cord stereotaxy are the different new technologies in the field of spinal navigation, mostly in use for the simulation[5] or actual placement of pedicle screws in spinal instrumentation in complex cases that also address spinal cord tumor anatomy. The outcome parameters here are the accuracy of pedicle screw placement and dose reduction of ionizing radiation.[6] Interestingly, these new developments - which already started in the 1990s - do not find entry into the reflections about the future of spinal cord stereotaxy. This might be, because of the functional work on the undistorted spinal cord being the research focus and main interest of the author. Despite this, we can congratulate Dr. Nadvornik for his influential and visionary work in the fascinating field of spinal cord stereotaxy in which he is one of the pioneers.

• References

• 1 Nadvornik P. Spinal Cord Stereotaxy: An Overview. J Neurol Surg 2015; 76: 318-322
• 2 Woroschiloff C. The course of motor sensory pathway in rabbit's spinal cord. Ber Säch Ges Wissenschaften Leipzig 1974; 26: 248-304
• 3 Gabriel EM, Nashold Jr BS. History of spinal cord stereotaxy. J Neurosurg 1996; 85 (4) 725-731
• 4 Sindou M, Mertens P, Wael M. Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients. Pain 2001; 92 (1-2) 159-171 Review
• 5 Spangenberg P, Coenen V, Gilsbach JM, Rohde V. Virtual placement of posterior C1-C2 transarticular screw fixation. Neurosurg Rev 2006; 29 (2) 114-117
• 6 Helm P, Teichman R, Hartmann S, Simon D. Spinal Navigation and Imaging: History, Trends and Future. IEEE Trans Med Imaging 2015;