The Saudi Journal of Medical Insights

ABSTRACT
The evolution of spinal surgery from a high-risk, largely empirical discipline to a precise and predictable specialty is
fundamentally intertwined with advancements in medical radiology. This article is a narrative review synthesizing evidence
from clinical studies, systematic reviews, and guidelines on the role of radiological imaging across the preoperative,
intraoperative, and postoperative phases of spinal surgery.The utility of radiology extends dynamically into the operating
room, where intraoperative guidance technologies—from real-time fluoroscopy to sophisticated 3D navigation and robotic
systems—transform these preosub-millimetric accuracyperative plans into executed reality with sub-millimetric accuracy,
drastically improving the safety and precision of instrumentation, particularly in complex and minimally invasive
procedures. Following surgery, radiology transitions to a vital monitoring tool, where serial imaging assesses the success of
decompression and fusion, evaluates spinal alignment, and facilitates the early detection of complications such as
pseudoarthrosis, implant failure, or adjacent segment disease. Despite facing challenges including radiation exposure, cost,
and technical artifacts, the continuous evolution of imaging technology and its symbiotic relationship with surgical
innovation persistently pushes the boundaries of what is achievable, solidifying radiology not as a mere adjunct but as a
fundamental pillar that directly elevates the efficacy, safety, and predictability of spinal surgical interventions, ultimately
translating into superior patient outcomes.