Article
Intraoperative CT-assisted spinal navigation in posterior cervical instrumentation – a report on accuracy compared to conventional instrumentation regarding different pathologies
Intraoperative CT-assistierte spinale Navigation bei dorsaler zervikaler Instrumentierung – ein Bericht über Genauigkeit im Vergleich zur konventionellen Instrumentierung in Bezug auf verschiedene Pathologien
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Authors
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Ulf Bertram
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hans Rainer Clusmann
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Matthias Florian Geiger
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Alexander Riabikin
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neuroradiologie, Aachen, Deutschland
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Christian Andreas Mueller
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Christian Blume
- Rheinisch-Westfälische Technische Hochschule Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: While the use of intraoperative fluoroscopic, isocentric 3D C-arm imaging is still the most common clinical practice, a growing number of medical centers have introduced intraoperative CT (iCT) navigated osterior instrumentation as a new clinical standard. Due to the close proximity of vital anatomical structures, instrumentations of the cervical spine pose an especiall delicate task. Navigated approaches might therefore prove to be beneficial regarding accurate screw placement. In this study we report on accuracy of conventional versus iCT-navigated posterior cervical spine instrumentation with focus on pedicle vs. lateral mass screws.
Methods: We analysed a consecutive series of cervical posterior instrumentation using iCT AIRO© as well as conventional instrumentation of the cervical spine. Patients with screw placement in C1/2, subaxial and combinations were included. The underlying pathologies were also taken into account. Each screw was individually assessed by an independent observer making use of a modified Gertzbein & Robbins classification.
Results: In total, 39 patients were treated using iCT (224 screws; 144 pedicle, 80 lat. mass screws), while 40 patients underwent conventional instrumentation (252 screws; 24 pedicle, 228 lat. mass screws). We achieved an initial accuracy of 94.2% (n=211 screws) with iCT- and 84,9% (n=214 screws) in the conventional (C) group (p=0.005). Additionally, significant differences were found regarding the accuracy of screw placement in cases of degenerative disorders (iCT vs. C; 93.7% vs. 82.8%; p=0.01). Other pathologies (trauma, pathological fractures, infectious) showed no significant differences in accuracy. Comparisons between accuracy of pedicle or lateral mass screw placement were found not significant (neither within, nor between iCT- and C-group).
Conclusion: The accuracy of iCT navigated instrumentation in the cervical spine was significantly higher than conventional screw-placement, reducing the risk of harming vital anatomical structures. Although no differences were found between lateral mass and pedicle screw accuracy, the overall tendency towards the use of pedicle screws with iCT navigation is evident, possibly increasing the mechanical properties of the implanted fixateur. AIRO© iCT appears to be especially strong in elective surgery cases of degenerative spinal disorders.
