scholarly journals Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

2015 ◽  
Vol 16 (5) ◽  
pp. 590-598 ◽  
Author(s):  
Timothy J. Kovanda ◽  
Shaheryar F. Ansari ◽  
Rabia Qaiser ◽  
Daniel H. Fulkerson
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Pediatric Patients ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Initial Experience ◽  
Cervical Spine Surgery ◽  
Image Guided ◽  
Surgical Tool ◽  
Upper Cervical

OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors’ initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

scholarly journals Prolonged Airway Obstruction after Posterior Occipitocervical Fusion: A Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Masahiro Morita ◽  
Masuhiro Nobuta ◽  
Hirotsune Naruse ◽  
Hiroaki Nakamura
Keyword(s):  
Radiation Therapy ◽  
Cervical Spine ◽  
Airway Obstruction ◽  
Spine Surgery ◽  
Metastatic Tumor ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Cervical Spine Surgery ◽  
Emergency Tracheostomy ◽  
Upper Cervical

The purpose of this paper was to inform the reader that prolonged upper airway obstruction after posterior cervical spine surgery is a possible complication for patients with metastatic tumor of upper cervical spine. A 49-year-old man presented severe neck pain during posture changes due to metastatic spinal tumor of C2. Occipitocervical fusion following removal of the posterior arch of C1 and laminectomy of C2 via the single posterior approach was performed 2 weeks after radiation therapy. After the surgery, life-threatening airway obstruction due to pharyngeal oedema occurred immediately after extubation that required emergency tracheostomy. The airway obstruction did not improve well during the patient's postoperative course. Once pharyngeal oedema occurs in patients with metastatic tumor of upper cervical spine who undergo posterior cervical spine surgery following radiation therapy to the neck, the pharyngeal oedema may be constant for a long period of time.

Feasibility of mixed reality–based intraoperative three-dimensional image-guided navigation for atlanto-axial pedicle screw placement

2019 ◽  
Vol 233 (12) ◽  
pp. 1310-1317 ◽  
Author(s):  
Xinghuo Wu ◽  
Rong Liu ◽  
Song Xu ◽  
Cao Yang ◽  
Shuhua Yang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Mixed Reality ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Upper Cervical Spine ◽  
Pedicle Screw Placement ◽  
Image Guided ◽  
Upper Cervical

This study aimed to evaluate the safety and accuracy of mixed reality–based intraoperative three-dimensional navigated pedicle screws in three-dimensional printed model of fractured upper cervical spine. A total of 27 cervical model from patients of upper cervical spine fractures formed the study group. All the C1 and C2 pedicle screws were inserted under mixed reality–based intraoperative three-dimensional image-guided navigation system. The accuracy and safety of the pedicle screw placement were evaluated on the basis of postoperative computerized tomography scans. A total of 108 pedicle screws were properly inserted into the cervical three-dimensional models under mixed reality–based navigation, including 54 C1 pedicle screws and 54 C2 pedicle screws. Analysis of the dimensional parameters of each pedicle at C1/C2 level showed no statistically significant differences in the ideal and the actual entry points, inclined angles, and tailed angles. No screw was misplaced outside the pedicle of the three-dimensional printed model, and no ionizing X-ray radiation was used during screw placement under navigation. It is easy and safe to place C1/C2 pedicle screws under MR surgical navigation. Mixed reality–based navigation is feasible within upper cervical spinal fractures with improved safety and accuracy of C1/C2 pedicle screw insertion.

Motor Evoked Potential Monitoring during Upper Cervical Spine Surgery

Spine ◽  
1989 ◽  
Vol 14 (10) ◽  
pp. 1078-1083 ◽  
Author(s):  
HIDEKI KITAGAWA ◽  
TATSUO ITOH ◽  
HARUO TAKANO ◽  
KAZUHIKO TAKAKUWA ◽  
NAOYA YAMAMOTO ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Upper Cervical Spine ◽  
Cervical Spine Surgery ◽  
Upper Cervical ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

2021 ◽  
pp. 219256822110391
Author(s):  
Yakubu Ibrahim ◽  
Hao Li ◽  
Geng Zhao ◽  
Suomao Yuan ◽  
Yiwei Zhao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Neck Disability Index ◽  
Pedicle Screws ◽  
Rotary Motion ◽  
Upper Cervical Spine ◽  
Complex Fractures ◽  
Upper Cervical ◽  
Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

scholarly journals The use of intraoperative navigation for complex upper cervical spine surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E5 ◽  
Author(s):  
Kern H. Guppy ◽  
Indro Chakrabarti ◽  
Amit Banerjee
Keyword(s):  
Cervical Spine ◽  
Navigation System ◽  
Surgical Navigation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Cervical Canal ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

Image-guided, endoscopic, transcervical resection of cervical chordoma

2010 ◽  
Vol 12 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Wesley Hsu ◽  
Thomas A. Kosztowski ◽  
Hasan A. Zaidi ◽  
Ziya L. Gokaslan ◽  
Jean-Paul Wolinsky
Keyword(s):  
Cervical Spine ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Transcervical Approach ◽  
Image Guided ◽  
Adjacent Structures ◽  
Upper Cervical ◽  
Cervical Chordoma

Chordomas are rare tumors that arise from the sacrum, spine, and skull base. Surgical management of these tumors can be difficult, given their locally destructive behavior and predilection for growing near delicate and critical structures. En bloc resection with negative margins can be difficult to perform without damaging adjacent structures and causing significant clinical morbidity. For chordomas of the upper cervical spine, surgical options traditionally involve transoral or submandibular approaches. The authors report the use of the image-guided, endoscopic, transcervical approach to the upper cervical spine as an alternative to traditional techniques for addressing upper cervical spine tumors, particularly for tumors where gross-total resection is not feasible.

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