Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

Abstract

This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT-) guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490) and intraoperative blood loss was 407 cc (range, 50–1,200). The average duration of hospital stay was 48.9 days (range, 11–76). Out of a total of 54 pedicle screws employed, 53 screws (98.1%) were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2) and Oswestry disability index (from 67.1% to 25.6%) were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr) and average C-reactive protein (from 54.4 to 4.8 mg/dL). Average kyphotic angle correction was 10.5° (range, 8.4°–12.6°) postoperatively and 8.5° (range, 6.9°–10.1°) after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient's lateral decubitus position.

Use of an aiming device and computed tomography for assisted debridement of subchondral cystic lesions in the limbs of horses

“…In human medicine, CT is used not only for diagnostic purposes but also to guide therapeutic procedures in bone and soft tissues as well as in areas deep within the body that are difficult to access by using open approaches and for small lesions not visible with 2D imaging . The use of 2D imaging modalities such as fluoroscopy and radiography do not allow proper visualization of small SCL, making debridement extremely difficult; drilling in the wrong direction may lead to penetration of the subchondral bone resulting in weakened bone and the risk of fractures during recovery .…”

Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

“…But delayed diagnosis and treatment of spondylitis are common because of their early variable clinical manifestations and indolent courses, which may lead to the failure of conservative treatment [ 5 ]. Surgical treatment is reserved for patients with failed conservative therapy, including intractable spinal pain, large epidural abscesses, and extensive vertebral body destruction [ 6 ]. The major purpose of surgical intervention in spondylodiscitis is to remove the infected tissues, relieve spinal pain, rebuild the spinal stability, and improve limb dysfunction.…”