Accuracy and Safety of Neuronavigation for Minimally Invasive Stabilization in the Thoracolumbar Spine Using Polyaxial Screws-Rod: A Canine Cadaveric Proof of Concept

Abstract

Objectives The main aim of this study was to evaluate the feasibility of minimally invasive stabilization with polyaxial screws-rod using neuronavigation and to assess accuracy and safety of percutaneous drilling of screw corridors using neuronavigation in thoracolumbar spine and compare it between an experienced and a novice surgeon. Study Design Feasibility of minimally invasive polyaxial screws-rod fixation using neuronavigation was first performed in the thoracolumbar spine of two dogs. Accuracy and safety of drilling screw corridors percutaneously by two surgeons from T8 to L7 in a large breed dog using neuronavigation were established by comparing entry and exit points coordinates deviations on multiplanar reconstructions between preoperative and postoperative datasets and using a vertebral cortical breach grading scheme. Results Feasibility of minimally invasive stabilization was demonstrated. For the experienced surgeon, safety was 100% and mean (standard deviation) entry point deviations were 0.3 mm (0.8 mm) lateral, 1.3 mm (0.8 mm) ventral and 0.7 mm (1.8 mm) caudal. The exit points deviations were 0.8 mm (1.9 mm) lateral, 0.02 mm (0.9 mm) dorsal and 0.7 mm (2.0 mm) caudal. Significant difference in accuracy between surgeons was found in the thoracic region but not in the lumbar region. Accuracy and safety improvement are noted for the thoracic region when procedures were repeated by the novice. Conclusion This proof of concept demonstrates that using neuronavigation, minimally invasive stabilization with polyaxial screws-rod is feasible and safe in a large breed dog model.

Implantation Corridors in Canine Thoracic Vertebrae: A Morphometric Study in Dogs of Varying Sizes

“…1 Increased use of intraoperative guidance may obviate much of the risk associated with thoracic vertebral pedicle implants, optimizing implant strength while reducing the potential for iatrogenic trauma. 6,14,15 Various techniques have been described to assist with implant placement in the canine thoracic spine, including fluoroscopic guidance, 6 infrared optical neuronavigation, 15 and three-dimensionally (3D) printed drill guides. [16][17][18][19] The use of 3D printed drill guides has shown minimal risk of cortical violations when creating drill tracts or placing vertebral implants into canine thoracic pedicles, ranging from no violations 17,18 and 96.2% optimal placement 19 in cadaveric studies to 89.6 to 97.7% optimal placement in clinical cases.…”

“…1 Increased use of intraoperative guidance may obviate much of the risk associated with thoracic vertebral pedicle implants, optimizing implant strength while reducing the potential for iatrogenic trauma. 6 14 15…”

Spinal Neuronavigation for Lumbar Plate Fixation in Miniature Breed Dogs

“…As described in Guevar and colleagues, the system, therefore, calculates the distance between the patient tracker and the CT data. 31 To perform the navigation, a pointer device or another tracker device fitted with more fiducials is brought into the visual field of the infrared camera and the distance between the tracker and the CT data is automatically calculated following a calibration step. From there, the O-arm can be removed from the operation suite and the surgeon navigates in real-time.…”

“…27 In veterinary medicine, publications on the use of neuronavigation are scarce and include brain biopsy procedures [28][29][30] and minimally invasive spinal surgery applications in dogs. 31 The objectives of this pilot study are to assess the feasibility, accuracy, and safety of spinal neuronavigation for plate fixation of lumbar vertebrae in miniature breed dogs performed by a novice surgeon.…”

Application accuracy of a frameless optical neuronavigation system as a guide for craniotomies in dogs

“…Modern neuronavigation systems are becoming increasingly important in small animal medicine for neurosurgical interventions, such as brain biopsies, removal of brain tumors or other brain surgery indications like the insertion of electrodes for deep brain stimulation [1][2][3][4][5][6][7][8]. Recently there have also been initial efforts to use neuronavigation systems in the eld of spinal surgery in small animals [9].…”