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Journal of Neurosurgical Sciences 2016 May 04

language: English

Real-time navigation in spinal surgery: what has it changed in surgical practice?

Paolo ROCCUCCI, Stefano PERON, Matteo R. MINOTTI, Roberto STEFINI

Department of Neurosurgery, Legnano Civil Hospital, Legnano, Italy


BACKGROUND: The authors have carried out a retrospective study to assess the advantages of real-time spinal navigation with 3D-fluoro images (O-Arm® and StealthStation® navigation systems, Medtronic) versus fluoroscopy in spinal surgery. The aim of the study is to ascertain whether this technology has affected surgical indications and clinical practice.
METHODS: From January 2009 to December 2013, 421 patients underwent image-guided spinal surgery procedures in our department. They were divided into two main groups: Group 1: operated on with C-arm fluoroscopic control; Group 2: operated on with real-time navigation with 3D-fluoro images. All patients with vertebral osteosynthesis underwent a post-operative CT scan to check the final position of the screws.
RESULTS: The screw misplacement proved to be 5.8% in group 1 and 1.5% in group 2. The odds ratio was 4.2 (95% confidence interval 2.3–7.5) with statistical significance (p<0.0001). The results clearly show an increased number of percutaneous procedures in group 2, as well as longer open osteosynthesis.
CONCLUSIONS: Navigation with 3D-fluoro images reduces screw misplacement, facilitates osteosynthesis in the most difficult vertebral segments and allows broader use of percutaneous techniques, when indicated.

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