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JOURNAL OF NEUROSURGICAL SCIENCES
A Journal on Neurosurgery
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2015 Sep 02
Alternative radiation-free registration technique for image-guided pedicle screw placement in deformed cervico-thoracic segments
Kantelhardt S. R., Neulen A., Keric N., Gutenberg A., Conrad J., Giese A. ✉
Dept. of Neurosurgery, University Medical Centre Mainz
AIM: Image-guided pedicle screw placement in the cervico-thoracic region is a commonly applied technique. In some patients with deformed cervico-thoracic segmentes, conventional or 3D fluoroscopy based registration of image-guidance might be difficult or impossible because of the anatomic/pathological conditions. Landmark based registration has been used as an alternative, mostly using separate registration of each vertebra. We here investigated a routine for landmark based registration of rigid spinal segments as single objects, using cranial image-guidance software.
METHODS: Landmark based registration of image-guidance was performed using cranial navigation software (Patient Browser 2.0, Brainlab). After surgical exposure of the spinous processes, lamina and facet joints and fixation of a reference marker array, up to 26 predefined landmarks were acquired using a pointer. All pedicle screws were implanted using image guidance alone. Following image- guided screw placement all patients underwent postoperative CT scanning. Screw positions as well as intraoperative- and clinical parameters were retrospectively analyzed.
RESULTS: 13 patients received 73 pedicle screws at levels C6 to Th8. Registration of spinal segments, using the cranial image-guidance succeeded in all cases. Pedicle perforations were observed in 11.0%, severe perforations of >2mm occurred in 5.4 %. One patient developed a transient C8 syndrome and had to be revised for deviation of the C7 pedicle screw. No other pedicle screw-related complications were observed.
CONCLUSIONS: In selected patients suffering from pathologies of the cervico-thoracic region, which impair intraoperative fluoroscopy or 3D C-arm imaging, landmark based registration of image- guidance using cranial software is a feasible, radiation-saving and a safe alternative.