gms | German Medical Science

Objective: Cervical corpectomy with anterior plating is a common applied treatment option for severe degenerative spinal disease or cervical spinal tumours. Optimal implant positioning is often challenging especially in the lower segments of the cervical spine. Although commonly practiced the rate of perioperative complications and postoperative morbidity remains relatively high due to misplacement of implants. The aim of this study was to optimize implant positioning by applying spinal navigation for the anterior cervical reconstructive surgery.

Methods: After standard supine positioning for an anterior cervical approach, an additional Mayfield clamp with an attached reference array was fixed to the patient’s head. An intraoperative Dyna-CT with a 3D robotic C-arm was then performed followed by an autoregistration process. The surgical approach to the anterior spine, the corpectomies and screw placement for anterior plating were all performed with navigational guidance. Cages were placed under fluoroscopy. Cranial-caudal, midline, anterior-posterior and lateral borders of the cages and plates were verified with the navigation to asses final positioning. If necessary, objects, e.g. tumours or vessels, were segmented on preoperative CT scans and fused with the intraoperative images. We then conducted comparative analysis with postoperative images.

Results: A total of 16 patients, 9 women and 7 men, underwent navigated anterior cervical reconstructive spine surgery at our department from June 2017. Of these 16 cases 11 patients were treated due to degenerative spine disease and 5 had metastasis of the cervical spine.3 patients underwent anterior cervical reconstruction between the levels C6 and Th1, 9 patients between C5 and C7 and 4 between C4 and C6. No perioperative complications in respect to implant displacement were detected. Postoperative scans revealed optimal positioning of the cages, screws and plates respectively in all patients. Surgical time was merely increased by 6 minutes on average.

Conclusion: This study demonstrates that the use of spinal navigation for cervical anterior reconstructive surgery seems advantageous for optimal implant positioning. This technique can potentially reduce the risks of implant associated peri- and postoperative complications or iatrogenic morbidities especially of the lower cervical segments.