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Journal of Neurosurgical Sciences 2017 October;61(5):464-72

DOI: 10.23736/S0390-5616.16.03311-7

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Alternative radiation-free registration technique for image-guided pedicle screw placement in deformed cervico-thoracic segments

Sven R. KANTELHARDT , Axel NEULEN, Naureen KERIC, Angelika GUTENBERG, Jens CONRAD, Alf GIESE

Department of Neurosurgery, University Medical Centre, Mainz, Germany


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BACKGROUND: Image-guided pedicle screw placement in the cervico-thoracic region is a commonly applied technique. In some patients with deformed cervico-thoracic segments, 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. 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: Thirteen 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 >2 mm 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.


KEY WORDS: Neuronavigation - Pedicle screws - Radiation

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