ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2019 August;63(4):402-10

DOI: 10.23736/S0390-5616.16.03647-X

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

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

Paolo ROCCUCCI, Stefano PERON ✉, Matteo MINOTTI, Roberto STEFINI

Department of Neurosurgery, Legnano Civil Hospital, Legnano, Milan, 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, Minneapolis, MN, USA) 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 postoperative 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.

KEY WORDS: Pedicle screws; Spinal cord; Surgery, computer-assisted