Innovations in Spine Surgery: A Narrative Review of Current Integrative Technologies.

Neurosurgical technologies have become increasingly more adaptive, featuring real-time and patient-specific guidance in pre, intra, and postoperative settings. This review offers insight on how these integrative innovations compare to conventional approaches in spine surgery, focusing on Machine Learning (ML), Artificial Intelligence (AI), Augmented Reality (AR) and Virtual Reality (VR), and Spinal Navigation Systems. Data on technology applications, diagnostic and procedural accuracy, intraoperative times, radiation exposures, post-operative outcomes, and costs were extracted and compared to conventional methods to assess their advantages and limitations. Preoperatively, AR and VR have applications in surgical training and planning that are more immersive, case-specific, and risk-free and have been shown to enhance accuracy and reduce complications. In addition, ML algorithms have demonstrated high accuracy in predicting surgical candidacy (up to 92.1%) and tailoring personalized treatments based on patient-specific variables. Intraoperatively, advantages include more accurate pedicle screw insertion (96-99% with ML), enhanced visualization, reduced radiation exposure (49 μSv with O-arm navigation vs. 556 μSv with fluoroscopy), increased efficiency, and potential for fewer intraoperative complications compared to conventional approaches. Postoperatively, certain ML and AI models have outperformed conventional methods in predicting all post-operative complications of 6000+ patients as well as predicting variables contributing to in-hospital and 90-day mortality. However, applying these technologies comes with limitations, such as longer operative times (up to 35.6% longer) with navigation, dataset dependencies, costs, accessibility, steep learning curve, and inherent software malfunctions. As these technologies advance, continuing to assess their efficacy and limitations will be imperative in their integration within spine surgery.