Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation

2019 ◽  
Vol 122 ◽  
pp. e1266-e1274 ◽  
Author(s):  
James Y.H. Yu ◽  
Jared Fridley ◽  
Ziya Gokaslan ◽  
Albert Telfeian ◽  
Adetokunbo A. Oyelese
2015 ◽  
Vol 11 (2) ◽  
pp. 259-267 ◽  
Author(s):  
Paul Park

Abstract BACKGROUND As with most minimally invasive spine procedures, lateral lumbar interbody fusion (LLIF) requires the use of biplanar fluoroscopy for localization and safe interbody cage placement. Computed tomography (CT)-based intraoperative spinal navigation has been shown to be more effective than fluoroscopic guidance for posterior-based approaches such as pedicle screw instrumentation. However, the use of spinal navigation in LLIF has not been well studied. OBJECTIVE To present the technique for using an intraoperative cone-beam CT and image-guided navigation system in LLIF and to provide a preliminary analysis of outcomes. METHODS We retrospectively analyzed a prospectively acquired database and the electronic records of patients undergoing LLIF with spinal navigation. Eight patients were identified. Postoperative neurological deficits were recorded. All patients underwent postprocedural CT and x-ray imaging for analysis of accuracy of cage placement. Accuracy of cage placement was determined by location within the disk space. RESULTS The mean age was 66 years, and 6 patients were women. A mean 2.8 levels were treated with a total of 22 lateral cages implanted via navigation. All cages were placed within quarters 1 to 2 or 2 to 3, signifying the anterior half or middle portions of the disk space. There were no sensory or motor deficits postoperatively. CONCLUSION Use of an intraoperative cone-beam CT with an image-guided navigation system is feasible and safe and appears to be accurate, although a larger study is required to confirm these results.


2021 ◽  
Author(s):  
Christopher Alvarez-Breckenridge ◽  
Matthew Muir ◽  
Laurence D Rhines ◽  
Claudio E Tatsui

Abstract BACKGROUND With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.


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