gms | German Medical Science

Objective: Spinal image guidance has undergone significant evolution and rapid technological advancement in recent years. Image guidance provides three-dimensional visualization of the spine that can be used for preoperative planning and intraoperative navigation. There are three commonly used methods of spinal image guidance: preoperative CT-based, fluoroscopy-based, and 3D fluoroscopy. We present our results with the use of 3D-fluoroscopy-based navigation for transpedicular fixation of the cervical spine.

Methods: A total of 52 patients had 212 screws placed with the aid of isocentric C-arm 3D navigation. Indications for surgery included trauma (n=4), degenerative disease (n=41), and tumor (n=7). All patients underwent postoperative computed tomography scanning, and an independent reviewer graded all screws based on axial, sagittal, and coronal projections for a full determination of the placement of the screw in the pedicle.

Results: Intraoperative navigation data acquisition time was 10±7 minutes. 30 patients (57%) required more than 1 data set. The rate of unintended perforations of the medial pedicle wall was 33 out of 212 (15%) and was found to correlate with the pedicle diameter. Overall, there were no neurological or vascular complications.

Conclusions: The reported technique allows safe and efficient transpedicular instrumentation of the cervical spine. Nevertheless, the significant number of unintended pedicle wall perforations reported in this study demonstrates the vulnerability of the system and the importance of a thorough knowledge of the anatomy as well as additional intraoperative fluoroscopy. Recently published concerns referring to prolongation of operation time, the increase of patient exposure to radiation and the needed learning curve could not be verified.