Artikel
Intraoperative computed tomography in spine surgery
Intraoperative Computertomographie in der Wirbelsäulenchirurgie
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Autoren
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K. Shariat
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes
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T. R. Pitzen
- SRH Wald-Klinikum Gera
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A. Nabhan
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes
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W. I. Steudel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Spine surgery, including decompression and stabilization, can be challenging due to small geometry of important bony structures such as facets and pedicles, anatomical variations (i.e. the course of the vertebral artery within the axis), and close anatomical relationship of the bone to the spinal cord, roots, and vessels. There is some evidence, that the use of navigation tools in this type of surgery does not minimize risk of screw malposition. Intraoperative computed tomography may be helpful here, giving possibility to correct the position of the implants or widening decompression before wound is closed.
Methods: This is a prospective study on 70 patients, having undergone spine surgery for a variety of indications and therefore using different types of spine fixation devices. Two experienced spine surgeons performed surgery. 250 screws and 60 cages or bone grafts were placed within the spine. The position of both the implants as well as the degree of decompression was checked using the intraoperative computed tomography.
Results: Decompression was necessary in 50 out of 70 patients. In each of these patients, decompression was sufficient and any widening of the decompression was not necessary in any of these. However 15 screws out of 250 (6%) screws were misplaced and were changed. Repeated computed tomography showed that the screws were thereafter all placed correctly.
Conclusions: The use of intraoperative computed tomography is a useful tool to check surgical procedures within the spine. It has to be defined as a postoperative control, not as an online control as it is a navigation tool. However, shift of vertebral bodies, as it is a disadvantage of navigation, can be avoided here. Thus, thus it will not replace intraoperative navigation but really complete it. Moreover, costs of revision surgery will be avoided or at least be reduced. In this study intraoperative computed tomography following spine surgery was useful to check the dimensions of spine decompression as well as position of the implants. The intraoperative picture giving by means of a high resolution CT enables the surgeon to have a quality and learning control. Its usefulness is also obvious in the presence of a 6% rate of implant revision and is an effective procedure to avoid secondary operations.
