NAVIGATION-GUIDED SPINAL TUMOR SURGERY: ADVANCEMENTS AND CLINICAL APPLICATIONS

Spinal tumor surgery represents a high-risk field due to its proximity to critical neural and vascular structures, while simultaneously requiring oncological precision. In recent decades, the introduction of image-based navigation systems has revolutionized spinal oncology by enhancing accuracy, safety, and feasibility of complex interventions. Navigation technology improves pedicle screw placement, facilitates the achievement of safe tumor margins, and broadens the applicability of minimally invasive procedures. Historically, the evolution began with X-ray and computed tomography (CT) imaging, progressed through frameless stereotaxy in the 1990s, intraoperative CT and O-arm systems in the 2000s, and has now advanced to augmented reality (AR), robotics, and artificial intelligence (AI) integrated platforms. In oncological spine surgery, navigation is applied in thoracic and lumbar me-tastases for stabilization, in cervical chordomas and metastases for high-precision instrumentation, in intradural extramedullary tumors for margin delineation, and in minimally invasive procedures such as vertebroplasty and ablative therapies. Clinical studies consistently report reduced blood loss, shorter operative times, decreased occupational radiation exposure, and higher accuracy of instrumentation with navigation-assisted approaches. Nonetheless, limitations such as high cost, setup time, and tech-nical constraints remain. Future directions include AI-driven automated registration, low-dose im-aging protocols, AR/VR-based (Augmented reality/Virtual Reality) intraoperative visualization, and patient-specific navigation models, all of which may overcome current challenges. Considering the historical evolution, technological foundations, current clinical applications, and future perspectives of navigation-guided spinal tumor surgery, the findings demonstrate that navigation should be regarded not merely as a technical innovation, but as an integral component of multidisciplinary oncological care.