Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

[1]  Jie Zhang,et al.  Dosimetric characterization of a cone-beam O-arm imaging system. , 2009, Journal of X-ray science and technology.

[2]  Rani Nasser,et al.  Clinical Assessment of Percutaneous Lumbar Pedicle Screw Placement Using the O-Arm Multidimensional Surgical Imaging System , 2012, Neurosurgery.

[3]  Doniel Drazin,et al.  Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image-guided surgery. , 2014, Neurosurgical focus.

[4]  Maurizio Fornari,et al.  Spinal Navigation: Standard Preoperative Versus Intraoperative Computed Tomography Data Set Acquisition for Computer-Guidance System Radiological and Clinical Study in 100 Consecutive Patients , 2011, Spine.

[5]  T. Lund,et al.  A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation , 2000, European Spine Journal.

[6]  Kevin T. Foley,et al.  Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results , 2010, Surgical neurology international.

[7]  F. Costa,et al.  A Prospective Multicenter Registry on the Accuracy of Pedicle Screw Placement in the Thoracic, Lumbar, and Sacral Levels With the Use of the O-arm Imaging System and StealthStation Navigation , 2012, Spine.

[8]  Chee Keong Chan,et al.  The accuracy of 3D image navigation with a cutaneously fixed dynamic reference frame in minimally invasive transforaminal lumbar interbody fusion , 2012, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[9]  I. Lieberman,et al.  Radiation Exposure to the Surgeon During Percutaneous Pedicle Screw Placement , 2011, Journal of spinal disorders & techniques.

[10]  A. Sayadipour,et al.  Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study. , 2010, World neurosurgery.

[11]  K. Wood,et al.  Navigated placement of iliac bolts: description of a new technique. , 2011, The spine journal : official journal of the North American Spine Society.

[12]  R. Härtl,et al.  Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. , 2012, Journal of neurosurgery. Spine.

[13]  D. Drazin,et al.  CT navigated lateral interbody fusion , 2013, Journal of Clinical Neuroscience.

[14]  Y. Rampersaud,et al.  Radiation Exposure to the Spine Surgeon During Fluoroscopically Assisted Pedicle Screw Insertion , 2000, Spine.

[15]  D. Drazin,et al.  Economics of image guidance and navigation in spine surgery , 2015, Surgical neurology international.

[16]  S. Esses,et al.  Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. , 1993, Spine.

[17]  V. Schreiber,et al.  Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. , 2011, Journal of neurosurgery. Spine.

[18]  Thomas J Gianaris,et al.  Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires: clinical article. , 2013, Journal of neurosurgery. Spine.

[19]  W. Castro,et al.  Accuracy of Pedicle Screw Placement in Lumbar Vertebrae , 1996, Spine.

[20]  Jin-Sung Kim,et al.  Modified transcorporeal anterior cervical microforaminotomy assisted by O-arm-based navigation: a technical case report , 2011, European Spine Journal.

[21]  Doniel Drazin,et al.  Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation. , 2014, Neurosurgical focus.

[22]  D. Drazin,et al.  Accuracy of intraoperative computed tomography image-guided surgery in placing pedicle and pelvic screws for primary versus revision spine surgery. , 2014, Neurosurgical focus.

[23]  Doniel Drazin,et al.  Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation. , 2014, Neurosurgical focus.

[24]  A Hamadeh,et al.  Computer Assisted Spine Surgery , 1997, Clinical orthopaedics and related research.

[25]  Donald A. Smith,et al.  O-Arm-based image guidance in minimally invasive spine surgery: Technical note , 2013, Clinical Neurology and Neurosurgery.

[26]  M. Gutberlet,et al.  Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques , 2011, European Spine Journal.

[27]  D. Drazin,et al.  Introduction: Intraoperative spinal imaging and navigation. , 2014, Neurosurgical focus.

[28]  Rick Sasso,et al.  Comparison of Radiation Exposure in Lumbar Pedicle Screw Placement With Fluoroscopy Vs Computer-Assisted Image Guidance With Intraoperative Three-Dimensional Imaging , 2008, The journal of spinal cord medicine.

[29]  Jin-Sung Kim,et al.  Minimally invasive posterior cervical microforaminotomy in the lower cervical spine and C-T junction assisted by O-arm-based navigation , 2013, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[30]  Hua-Zi Xu,et al.  Image-guided pedicle screw insertion accuracy: a meta-analysis , 2009, International Orthopaedics.

[31]  Phillip M Young,et al.  Image‐Guided Placement of Occipitocervical Instrumentation Using a Reference Arc Attached to the Headholder , 2010, Neurosurgery.

[32]  M. O’Brien,et al.  Radiation Exposure During Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: Is Fluoroscopy Safe? , 2006, Spine.

[33]  Rick C Sasso,et al.  Computer-assisted Spinal Navigation Versus Serial Radiography and Operative Time for Posterior Spinal Fusion at L5-S1 , 2007, Journal of spinal disorders & techniques.