The Global Landscape of Spine-focused Neuronavigation: Insights from a Systematic Literature Review

Introduction: Neuronavigation has substantially advanced spinal surgery, offering unprecedented precision and safety. This study explores the development, adoption, and impact of neuronavigation in spine surgery globally, focusing on technological advancements and their clinical implications.

Methods: Adhering to PRISMA guidelines, we conducted a systematic literature search across PubMed, Embase, and Scopus from January 1, 1990, to November 5, 2024. The search focused on studies related to the use of neuronavigation in spinal surgery in human subjects. Data extraction included citation counts, Relative Citation Ratios (RCR), Altmetric scores, procedural applications, and geographical distribution of studies.

Results: 109 publications met inclusion criteria, with a median citation count of 23 [IQR 6.5–82] and a median RCR of 3.54 [1.24–6.51]. US-based studies, though fewer (17), exhibited higher impact metrics, with a median citation count of 69 [20.5–93] and an RCR of 5.31 [3.43–6.53], compared to international. Optical neuronavigation systems were the most widely used (68.8%, p < 0.001), with US studies showing a higher preference for optical (82.4%) compared to international (66.3%). Electromagnetic systems were used in 29.4% of all studies, more prominently in US-based research (82.4%) than international studies (32.6%), while augmented reality systems accounted for 1%. Fixation was the predominant procedure, reported in 77.1% of studies, consistently across both US and international publications, followed by minimally invasive surgery (17.4%) and tumor-related procedures (3.67%). Cohort studies were the primary design (83.5%), with a slightly higher representation in US studies (88.2%) than international (82.6%). The analysis also revealed a pronounced research gap from LMICs/LICs, highlighting global disparities in access to neuronavigation technology in spinal surgery.

Conclusion : Neuronavigation has significantly impacted spinal surgery, particularly in high-income countries, as evidenced by higher citation metrics and adoption rates. The disparity in global research contributions underscores the need for increased support and collaboration to extend the benefits of neuronavigation to LMICs/LICs. Future research should focus on addressing these disparities, enhancing the inclusivity and accessibility of advanced surgical technologies worldwide, and further exploring the clinical outcomes associated with neuronavigation in spinal surgery.