Image-guided surgery: applications to the cervical and thoracic spine and a review of the first 120 procedures

2000 ◽  
Vol 92 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Ciaran Bolger ◽  
Crispin Wigfield
Keyword(s):  
Thoracic Spine ◽  
Spinal Surgery ◽  
Image Guidance ◽  
Preoperative Planning ◽  
Guidance System ◽  
Frameless Stereotaxy ◽  
Content Type ◽  
Guided Surgery ◽  
Surgical Implants ◽  
Fine Print

Object. The authors undertook a study to demonstrate that frameless stereotaxy can be applied safely to the cervical and thoracic spine to minimize complications and associated morbidity. Methods. A retrospective review of cases was conducted involving the use of an image-guidance system for the accurate placement of surgical implants or for resection of lesions within the cervical and thoracic spine. The outcome measures considered were neural injury, vascular injury, wound infection, surgical revision, and death. Conclusions. Image-guidance systems are useful intraoperative tools that can be applied accurately to spinal surgery. In addition, such systems can be of great use in the preoperative planning of complex spinal surgery.

Effect of frameless stereotaxy on the accuracy of C1–2 transarticular screw placement

2001 ◽  
Vol 95 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Orin Bloch ◽  
Langston T. Holly ◽  
Jongsoo Park ◽  
Chinyere Obasi ◽  
Kee Kim ◽  
...  
Keyword(s):  
Image Guidance ◽  
Vascular Anatomy ◽  
Ct Scanning ◽  
Screw Placement ◽  
Frameless Stereotaxy ◽  
Transarticular Screw ◽  
Anterior Cortex ◽  
Content Type ◽  
Pars Interarticularis ◽  
Fine Print

Object. In recent studies some authors have indicated that 20% of patients have at least one ectatic vertebral artery (VA) that, based on previous criteria in which preoperative computerized tomography (CT) and standard intraoperative fluoroscopic techniques were used, may prevent the safe placement of C1–2 transarticular screws. The authors conducted this study to determine whether frameless stereotaxy would improve the accuracy of C1–2 transarticular screw placement in healthy patients, particularly those whom previous criteria would have excluded. Methods. The authors assessed the accuracy of frameless stereotaxy for C1–2 transarticular screw placement in 17 cadaveric cervical spines. Preoperatively obtained CT scans of the C-2 vertebra were registered on a stereotactic workstation. The dimensions of the C-2 pars articularis were measured on the workstation, and a 3.5-mm screw was stereotactically placed if the height and width of the pars interarticularis was greater than 4 mm. The specimens were evaluated with postoperative CT scanning and visual inspection. Screw placement was considered acceptable if the screw was contained within the C-2 pars interarticularis, traversed the C1–2 joint, and the screw tip was shown to be within the anterior cortex of the C-1 lateral mass. Transarticular screws were accurately placed in 16 cadaveric specimens, and only one specimen (5.9%) was excluded because of anomalous VA anatomy. In contrast, a total of four specimens (23.5%) showed significant narrowing of the C-2 pars interarticularis due to vascular anatomy that would have precluded atlantoaxial transarticular screw placement had previous nonimage-guided criteria been used. Conclusions. Frameless stereotaxy provides precise image guidance that improves the safety of C1–2 transarticular screw placement and potentially allows this procedure to be performed in patients previously excluded because of the inaccuracy of nonimage-guided techniques.

Application of frameless stereotaxy to pedicle screw fixation of the spine

1995 ◽  
Vol 83 (4) ◽  
pp. 641-647 ◽  
Author(s):  
Iain H. Kalfas ◽  
Donald W. Kormos ◽  
Michael A. Murphy ◽  
Rick L. McKenzie ◽  
Gene H. Barnett ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Screw Fixation ◽  
Ct Images ◽  
Pedicle Screw Fixation ◽  
Lumbosacral Spine ◽  
Frameless Stereotaxy ◽  
Content Type ◽  
Screw Length ◽  
Fine Print

✓ Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Guidance System ◽  
Production Model ◽  
Ct Scanner ◽  
Content Type ◽  
Ct Scanners ◽  
Guidance Systems ◽  
Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

Osteoclastoma of the thoracic spine

1976 ◽  
Vol 44 (6) ◽  
pp. 748-752 ◽  
Author(s):  
Mohammed N. Gonem
Keyword(s):  
Thoracic Spine ◽  
The Body ◽  
Content Type ◽  
Prevention Of Recurrence ◽  
Fine Print

✓ A case of osteoclastoma arising in the body of the T-9 vertebra is presented. Osteoclastoma rarely involves the vertebrae, and treatment, whether by surgery or radiotherapy, seldom results in eradication of the lesion or prevention of recurrence.

Delayed myelopathy secondary to retained intraspinal metallic fragment

1981 ◽  
Vol 55 (6) ◽  
pp. 979-982 ◽  
Author(s):  
F. Douglas Jones ◽  
Ronald E. Woosley
Keyword(s):  
Thoracic Spine ◽  
Stab Wound ◽  
Good Recovery ◽  
Review Of The Literature ◽  
Content Type ◽  
Stab Wounds ◽  
Fine Print

✓ The authors present a case of delayed myelopathy arising 8 years after a stab wound to the thoracic spine, with intradural retention of the knife tip. Following removal of the knife tip, the patient had a good recovery. A review of the literature documents eight additional cases of delayed myelopathy secondary to retained fragments from spinal stab wounds.

Diagnosis and treatment of Ogilvie's syndrome after lumbar spinal surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 1012-1016 ◽  
Author(s):  
Robert A. Feldman ◽  
Richard C. Karl
Keyword(s):  
Spinal Surgery ◽  
Mechanical Obstruction ◽  
Ogilvie's Syndrome ◽  
Ogilvie’S Syndrome ◽  
Content Type ◽  
Cecal Perforation ◽  
Life Threatening ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Fine Print

✓ Three patients who developed Ogilvie's syndrome following lumbar spinal surgery are described. Ogilvie's syndrome, also known as pseudo-obstruction of the colon, is characterized by massive cecal distention without mechanical obstruction. If this condition is not recognized and not promptly treated, it may be complicated by cecal perforation, a life-threatening hazard. The etiology, diagnosis, management, and potential relationship between lumbar spinal surgery and Ogilvie's syndrome are discussed.

Lumbosacral intradural periradicular ossification

1978 ◽  
Vol 49 (1) ◽  
pp. 132-137 ◽  
Author(s):  
George Varughese
Keyword(s):  
Thoracic Spine ◽  
Lumbosacral Region ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Healthy Man ◽  
Sacral Canal ◽  
Fine Print

✓ Intrathecal ossification causing progressive myelopathy or radiculopathy does not occur frequently. The majority of the reported lesions have been in the thoracic spine and seldom in the sacral canal. This report presents the occurrence of disabling low backache and sciatica from intradural periradicular ossification in the lumbosacral region in a previously healthy man.

Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation

1998 ◽  
Vol 88 (4) ◽  
pp. 656-662 ◽  
Author(s):  
Neil L. Dorward ◽  
Olaf Alberti ◽  
Binti Velani ◽  
Frans A. Gerritsen ◽  
William F. J. Harkness ◽  
...  
Keyword(s):  
Skull Base ◽  
Skin Surface ◽  
Guidance System ◽  
Midline Shift ◽  
Content Type ◽  
Tumor Margin ◽  
Image Characteristics ◽  
Preoperative Image ◽  
The Impact ◽  
Fine Print

Object. This prospective study was conducted to quantify brain shifts during open cranial surgery, to determine correlations between these shifts and image characteristics, and to assess the impact of postimaging brain distortion on neuronavigation. Methods. During 48 operations, movements of the cortex on opening, the deep tumor margin, and the cortex at completion were measured relative to the preoperative image position with the aid of an image-guidance system. Bone surface offset was used to assess system accuracy and correct for registration errors. Preoperative images were examined for the presence of edema and to determine tumor volume, midline shift, and depth of the lesion below the skin surface. Results were analyzed for all cases together and separately for four tumor groups: 13 meningiomas, 18 gliomas, 11 nonglial intraaxial lesions, and six skull base lesions. For all 48 cases the mean shift of the cortex after dural opening was 4.6 mm, shift of the deep tumor margin was 5.1 mm, and shift of the cortex at completion was 6.7 mm. Each tumor group displayed unique patterns of shift, with significantly greater shift at depth in meningiomas than gliomas (p = 0.007) and significantly less shift in skull base cases than other groups (p = 0.003). Whereas the preoperative image characteristics correlating with shift of the cortex on opening were the presence of edema and depth of the tumor below skin surface, predictors of shift at depth were the presence of edema, the lesion volume, midline shift, and magnitude of shift of the cortex on opening. Conclusions. This study quantified intraoperative brain distortion, determined the different behavior of tumors in four pathological groups, and identified preoperative predictors of shift with which the reliability of neuronavigation may be estimated.

Intraoperative localization using an armless, frameless stereotactic wand

1993 ◽  
Vol 78 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Gene H. Barnett ◽  
Donald W. Kormos ◽  
Charles P. Steiner ◽  
Joe Weisenberger
Keyword(s):  
Operating Room ◽  
Microphone Array ◽  
Frameless Stereotaxy ◽  
Slice Thickness ◽  
Operating Table ◽  
Flexible Tool ◽  
Content Type ◽  
Signal Production ◽  
Intraoperative Localization ◽  
Fine Print

✓ A technique of “frameless” stereotaxy that allows real-time intraoperative neurosurgical localization is described. The system is composed of four components: a hand-held probe containing two ultrasonic emitters, a microphone array that is rigidly affixed to the operating table in proximity to the surgical field, hardware to control and detect timing of signal production and reception, and a color graphics computer workstation with software to calculate and present the location of the probe tip on reconstructed neuroimaging studies. Unlike previously reported mechanical or sonic navigational devices, this system is adaptable to a wide array of neurosurgical instruments, allows free movement of the operating table and conventional patient draping, and has accuracy in the hostile operating room environment that rivals that of frame stereotaxy. In the operating room environment, using four pulse pairs with the wand positioned optimally, reproducibility of a point in space is ± 0.6 mm. The wand has a broad range of orientations that maintain error at or below 1.0 mm. The mean error when measuring distances within a 1000-cu cm cube is 1.1 ± 1.0 mm (1.0% ± 0.7%). The ability to localize a fourth point (a target) in space is typically within 1.5 mm (using computerized tomography scans with a 1-mm slice thickness) but is dependent on several variables. This technology provides a powerful yet flexible tool in the neurosurgical operating room.

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