J Neurol Surg A Cent Eur Neurosurg 2015; 76(04): 322a
DOI: 10.1055/s-0035-1554927
Georg Thieme Verlag KG Stuttgart · New York

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

Volker A. Coenen
1   Department of Stereotactic and Functional Neurosurgery, Albert-Ludigs-University, Freiburg i.Br., Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 July 2015 (online)

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

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