gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Spinal navigation for posterior instrumentation of C1-C2 instability using a mobile intraoperative CT scanner

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  • Julien Haemmerli - Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Neurochirurgische Klinik, Berlin, Deutschland
  • Nils Hecht - Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Neurochirurgische Klinik, Berlin, Deutschland
  • Bettina Foehre - Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Anesthesiology and Intensive Care Medicine, Berlin, Deutschland
  • Klaus Arden - Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Anesthesiology and Intensive Care Medicine, Berlin, Deutschland
  • Thomas Liebig - Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Institut für Neuroradiologie, Berlin, Deutschland
  • Johannes Woitzik - Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Neurochirurgische Klinik, Berlin, Deutschland
  • Peter Vajkoczy - Charité - Universitätsmedizin Berlin, Campus Mitte, Neurochirurgische Klinik, Berlin, Deutschland
  • Marcus Czabanka - Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Neurochirurgische Klinik, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.21.07

doi: 10.3205/17dgnc298, urn:nbn:de:0183-17dgnc2985

Published: June 9, 2017

© 2017 Haemmerli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Spinal navigation techniques for surgical fixation of instable C1/2 pathologies are challenged by complex osseous and neurovascular anatomy, instability of the pathology and unreliable preoperative registration techniques. Intraoperative CT-scanner with autoregistration of C1/C2 promises adequate accuracy of spinal navigation without requiring further registration procedures. The aim of this study was to analyze accuracy and reliability of posterior C1/C2 fixation using intraoperative mobile-CT-scanner guided navigation.

Methods: From July 2014 to February 2016, 10 patients with instability of C1/C2 received posterior fixation using C2-pedicle and C1-lateral mass screws, and two patients received a posterior fixation from C1 to C3. Spinal navigation was performed using intraoperative mobile CT. Following navigated screw insertion in C1 and C2 intraoperative CT was repeated to check for accuracy of screw placement. Accuracy of screw positioning was retrospectively analyzed and graded by an independent observer.

Results: A total of 12 subjects were retrospectively analyzed, ten females and 2 males (mean age 80,7; range: 42-90). Instable pathologies (verified by fracture dislocation or by flexion/extension x-ray) included: 8 Anderson type II fractures, 1 instable Anderson type III fracture, 1 Hangman fracture Levine Effendi Ia, 1 complex Hangman-Anderson III and 1 destructive rheumatoid arthritis of C1-C2. In 4 patients, critical anatomy was observed: high riding vertebral artery (3 patients) and arthritis-induced partial osseous destruction of C1 lateral mass (1 patient). A total number of 52 screws were placed. Correct screw positioning was observed in 51 screws (98,1%). Minor pedicle breach was observed in 1 screw (1,9%). No screw displacement occurred (accuracy rate 98,1%).

Conclusion: Spinal navigation using intraoperative mobile CT scanning is reliable and safe for posterior fixation in instable C1/C2 pathologies with high accuracy in this patient series.