Intraoperative Computed Tomography-Assisted Spinal Navigation in Dorsal Cervical Instrumentation: A Prospective Study on Accuracy Regarding Different Pathologies and Screw Types

Ulf Bertram; Tobias Philip Schmidt; Hans Clusmann; Walid Albanna; Christian Herren; Alexander Riabikin; Christian A Mueller; Christian Blume

doi:10.1016/j.wneu.2021.02.014

Intraoperative Computed Tomography-Assisted Spinal Navigation in Dorsal Cervical Instrumentation: A Prospective Study on Accuracy Regarding Different Pathologies and Screw Types

World Neurosurg. 2021 May:149:e378-e385. doi: 10.1016/j.wneu.2021.02.014. Epub 2021 Feb 9.

Authors

Ulf Bertram¹, Tobias Philip Schmidt², Hans Clusmann², Walid Albanna², Christian Herren³, Alexander Riabikin⁴, Christian A Mueller², Christian Blume²

Affiliations

¹ Department of Neurosurgery, RWTH Aachen University, Aachen, Germany. Electronic address: ubertram@ukaachen.de.
² Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
³ Department of Orthopedic Trauma and Reconstructive Surgery, RWTH Aachen University, Aachen, Germany.
⁴ Department of Neuroradiology, RWTH Aachen University, Aachen, Germany.

PMID: 33578024
DOI: 10.1016/j.wneu.2021.02.014

Abstract

Background: Intraoperative computed tomography (iCT) navigated dorsal instrumentation has been successfully introduced as a new clinical standard. The proximity of vital anatomic structures makes cervical spine instrumentation an especially delicate task. Therefore, navigated approaches might prove to be beneficial. In this study, the accuracy of conventional instrumentation was compared with iCT navigated dorsal cervical spine instrumentation with focus on cervical pedicle screws (CPSs) versus lateral mass screws (LMSs) and pathologies.

Methods: We analyzed a prospective consecutive series of patients undergoing cervical dorsal instrumentation with iCT and spinal navigation and retrospectively analyzed a cohort that received conventional cervical instrumentation with C-arm fluoroscopy (control group). Accuracy was assessed with a modified Gertzbein-Robbins classification. Underlying pathologies were taken into account regarding accuracy in different entities.

Results: Fifty-nine patients were treated using iCT (357 screws: 238 CPSs, 119 LMSs), and 98 patients underwent conventional instrumentation (632 screws: 69 CPSs, 563 LMSs). We achieved an initial accuracy of 93.28% (n = 220 screws) in the iCT group and 80.9% (n = 511 screws) in the control group (P < 0.001). Significant differences were found regarding the accuracy of CPS placement in cases of degenerative disorders (iCT vs. control; 94% vs. 63%; P < 0.001) and trauma (iCT vs. control; 88% vs. 72%; P < 0.05). iCT yielded favorable precision rates in regard to LMS placement (iCT vs. control; 94.2% vs. 82%; P < 0.05).

Conclusions: Accuracy of iCT navigated instrumentation was significantly higher than conventional instrumentation. An overall tendency toward the use of CPSs with iCT navigation is evident, increasing the mechanical properties of the construct. iCT appears to be especially beneficial in elective surgery cases of degenerative spinal disorders.

Keywords: Accuracy; Cervical pedicle screws; Cervical spine; Intraoperative computed tomography; Lateral mass screws; Navigated instrumentation.

MeSH terms

Aged
Cervical Vertebrae
Female
Humans
Male
Middle Aged
Neuronavigation / methods*
Pedicle Screws
Spinal Fusion / instrumentation
Spinal Fusion / methods*
Tomography, X-Ray Computed / methods*