Preoperative CT Examination for Accurate and Safe Anterior Spinal Instrumentation Surgery with Endoscopic Approach

Abstract

The purpose of this article is to introduce a new procedure for the surgical planning of thoracic anterior spinal instrumentation via endoscopy. For accurate and safe anterior screw insertion via the endoscopic approach, we devised a surgical plan based on the preoperative chest computed tomography (CT) findings obtained with radiographic markers. Using this method, we performed endoscopic thoracic spinal instrumentation surgery in 14 patients. Nine patients underwent anterior endoscopic correction and fusion of idiopathic scoliosis by Cotrel-Dubousset instrumentation, and five patients underwent anterior endoscopic spinal fixation with instrumentation. The accuracy of screw insertion was evaluated postoperatively by CT scanning. One interbody fusion cage and 53 screws were inserted in the 14 patients using endoscopy. Postoperative CT scans revealed that the screws were all accurately inserted without any neurologic complications. In conclusion, using this novel procedure for surgical planning based on CT findings obtained with radiographic markers, anterior screws can be inserted safely and accurately via an endoscopic approach.

Comparison of two- and three-dimensional measurement of the Cobb angle in scoliosis

“…In these cases appropriate decisionmaking is essential as to whether the pedicle diameters are large enough for screw placement. A preoperative CT scan allows for safer screw sizing and positioning because it helps to assess the pedicle diameter [17]. The remaining CT reconstructions measured in the present study were carried out for other medical reasons than surgical planning.…”

Variability in Cobb Angle Measurements Using Reformatted Computerized Tomography Scans

“…Preoperative CT allows safer screw sizing and positioning. 30 Reformatted coronal plane images were produced from the transverse CT slices using the ImageJ image processing soft- …”

A semiautomatic method to identify vertebral end plate lesions (Schmorl's nodes)

“…This is higher than the combined dose for full-length posteroanterior and lateral standing radiographs (approximately 1.0 mSv) but substantially lower than a typical adult chest CT scan (approximately 8 mSv [16]). At the time of data collection, a single supine preoperative CT scan was part of the clinical assessment process for AIS patients undergoing single anterior rod instrumentation via the thoracoscopic approach to allow safer screw sizing and positioning [17]. Subsequently, we have obtained approval from the Human Research Ethics Committee of our institution to use the historical dataset of clinical CT scans for research purposes.…”