The use of intraoperative navigation for complex upper cervical spine surgery

Guppy, Kern H.; Chakrabarti, Indro; Banerjee, Amit

doi:10.3171/2014.1.focus13514

Cited by 28 publications

(12 citation statements)

References 27 publications

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“…Intraoperative navigation increases the accuracy of screw placement in spine surgery [ 7 - 9 ]. For example, Rajasekaran et al demonstrated a significantly decreased rate of pedicle breach in thoracic pedicle screw placement when compared to non-navigated screw placement [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report

Starkweather

Morshed

Rutledge

et al. 2020

Cureus

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Odontoid fractures are common cervical spine fractures and lead to atlantoaxial instability depending on their type. Fractures through the base of the odontoid neck are considered for surgery. While the management of these fractures is controversial and may include external immobilization or posterior fusion, an odontoid screw offers the advantages of directly crossing the fracture site while preserving motion at C1-2. Although intraoperative navigation is routinely utilized in spine surgery, there are few reports of navigated anterior odontoid screw placement. In this report, we describe the safe and accurate placement of two anterior odontoid screws using the O-arm navigation system in an octogenarian with a type II odontoid fracture. Details of the technical approach are also provided. The follow-up imaging at three months confirmed the healing of the fracture. Intraoperative navigation using the O-arm system allows for safe and accurate placement of two odontoid screws.

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Section: Discussionmentioning

confidence: 99%

Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report

Starkweather

Morshed

Rutledge

et al. 2020

Cureus

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“…Using the O-arm with navigation for anterior odontoid screw fixation may offer potential benefits compared with free-hand and fluoroscopy-based techniques, based on the prior literature for screw placement in other parts of the spinal column. For the patient, advantages of the O-arm include increased accuracy of screw placement 8,11 and the ability to perform an intraoperative CT to confirm the location of screw placement. 18 Immediate correction in the operating room may be performed rather than during a subsequent surgery.…”

Section: Discussionmentioning

confidence: 99%

“…9,15,19,20,27 Such adjuncts are meant to increase the safety and accuracy of screw placement. While there have been reports of Oarm navigation for posterior fixation in the upper cervical spine, including C-1 lateral mass, C-2 pars, pedicle screws, and laminar screws, 11,16 no studies are devoted solely to the study of anterior fixation for odontoid fractures. Thus, the purpose of this paper is to present in a stepwise fashion the technique for odontoid screw placement using the O-arm surgical navigation system.…”

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confidence: 99%

Navigated odontoid screw placement using the O-arm: technical note and case series

Pisapia

Nayak

Salinas

et al. 2017

SPI

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OBJECTIVE As odontoid process fractures become increasingly common in the aging population, a technical understanding of treatment approaches is critical. 3D image guidance can improve the safety of posterior cervical hardware placement, but few studies have explored its utility in anterior approaches. The authors present in a stepwise fashion the technique of odontoid screw placement using the Medtronic O-arm navigation system and describe their initial institutional experience with this surgical approach. METHODS The authors retrospectively reviewed all cases of anterior odontoid screw fixation for Type II fractures at an academic medical center between 2006 and 2015. Patients were identified from a prospectively collected institutional database of patients who had suffered spine trauma. A standardized protocol for navigated odontoid screw placement was generated from the collective experience at the authors' institution. Secondarily, the authors compared collected variables, including presenting symptoms, injury mechanism, surgical complications, blood loss, operative time, radiographically demonstrated nonunion rate, and clinical outcome at most recent follow-up, between navigated and nonnavigated cases. RESULTS Ten patients (three female; mean age 61) underwent odontoid screw placement. Most patients presented with neck pain without a neurological deficit after a fall. O-arm navigation was used in 8 patients. An acute neck hematoma and screw retraction, each requiring surgery, occurred in 2 patients in whom navigation was used. Partial vocal cord paralysis occurred after surgery in one patient in whom no navigation was used. There was no difference in blood loss or operative time with or without navigation. One patient from each group had radiographic nonunion. No patient reported a worsening of symptoms at follow-up (mean duration 9 months). CONCLUSIONS The authors provide a detailed step-by-step guide to the navigated placement of an odontoid screw. Their surgical experience suggests that O-arm–assisted odontoid screw fixation is a viable approach. Future studies will be needed to rigorously compare the accuracy and efficiency of navigated versus nonnavigated odontoid screw placement.

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“…31,37 Navigation also may aid in determining the extent of bony decompression. 13 Previously, pediatric upper cervical fusion was achieved with nonrigid fixation and onlay techniques with postoperative halo fixation. 27,32 Rigid screw fixation provides superior mechanical stability and improved fusion rates compared with nonrigid techniques.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Kovanda¹,

Ansari²,

Qaiser³

et al. 2015

PED

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OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors’ initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

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The use of intraoperative navigation for complex upper cervical spine surgery

Cited by 28 publications

References 27 publications

Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report

Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report

Navigated odontoid screw placement using the O-arm: technical note and case series

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

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