Artikel
Is the navigation for pedicular screw-insertion for the dorsal, multisegmental, transpedicular stabilization of the cervical column useful?
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Autoren
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Manfred Kudernatsch
- Klinik für Neurochirurgie und Epilepsiechirurgie, Labor für Neurochirurgische Mikroanatomie, Schön-Klinik Vogtareuth, Deutschland
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Michael Tiftikidis
- Klinik für Neurochirurgie und Epilepsiechirurgie, Labor für Neurochirurgische Mikroanatomie, Schön-Klinik Vogtareuth, Deutschland
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Harald Reischl
- Klinik für Neurochirurgie und Epilepsiechirurgie, Labor für Neurochirurgische Mikroanatomie, Schön-Klinik Vogtareuth, Deutschland
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Peter A. Winkler
- Klinik für Neurochirurgie und Epilepsiechirurgie, Labor für Neurochirurgische Mikroanatomie, Schön-Klinik Vogtareuth, Deutschland
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: The correct and safe multisegmental posterior cervical stabilization is still challenging. Main risks are screw dislocations and secondary instability, distortion of the alignment of the cervical spine and the intraoperative damage to neural and vascular structures. In order to reduce these risks, neuronavigation in procedures of dorsal cervical stabilization was introduced in 2007 at our institution.
Methods: From December 2007 until June 2009, 110 pedicular screws were placed under navigational control in 31 procedures with the aim of dorsal fusion of the cervical spine. 15 of the patients had already undergone previous surgical procedures in the cervical spine, 11 of which were ventral, 3 of which were dorsal and one of which was a dorso-ventral procedure. The age range of the studied population started as low as 3 years and reached as far as 87 years of age, representative of a wide range of different pathologies. 153 segments were stabilized, 4.94 segments per procedure. The mean duration of surgery was 294 minutes. Indications for pedicular screws were instabilities at levels C2, C7 and T1. Segments C3 through C6 were stabilized by lateral mass screw insertion. Correct screw-placement was documented by post-operative CT-scans in all included subjects.
Results: No surgery-related complications like damage to neural or vascular structures were encountered, neither were deteriorations in clinical neurological findings or postoperative instabilities. 1 misplacement occurred in 110 placed screws (0.91%). In one other case (0.91%) a screw-fracture occurred and in a third subject a patient suffering from PcP and showing bad compliance loosening of four screws (3.64%) occured.
Conclusions: The dorsal multisegmental fusion of the cervical spine by transpedicular screw insertion and with the aid of neuronavigation represents a safe method with a very low complication rate. Perhaps the single screw-displacement that was observed could have been avoided by additionally using intraoperative fluoroscopy. We therefore recommend regular use of additional fluoroscopy, since radiation exposure is low using neuronavigation.
