3-D spinal canal reconstruction: virtual reality and postsurgical reality

Abstract

Purpose: Cervical myelopathy is a problem from both neurosurgical and orthopaedic view. The cause may be osteochondrotic changes or multiple-level stenosis of the cervical spinal canal together with spinal cord changes, clinically correlating with the disturbance of the long spinal tracts function, with an equivalent derived from imaging methods being the deficiency of spinal cord blood vessels and T2 WI changes visible on MRI. The aim of this paper was to verify the cause of cervical spondylotic myelopathy in various spinal segments and surgery, which is targeted towards the offending lesion. Methods: 3-D reconstruction of the spinal canal derived from both CT and MRI images enables presurgical planning in virtual reality in advance before the surgical procedure and it is possible to individualise the choice of the implanted material for the reconstruction of the spinal canal. The surgical procedure itself is usually performed in two steps and is directed towards the reconstitution of the spinal canal according to the virtual reality conditions. Results: Seven patients were operated on for multi-level cervical stenosis extending from C2 to C7. The real image is presented as a result of postsurgical neuroradiological investigations and is compared with the presurgical virtual reality. Conclusions: The results of surgeries presented in 2-D reconstruction do not enable the exact spatial imaging of the spinal canal and may therefore be the cause of surgical failures. CT and MRI 3-D reconstruction makes possible presurgical planning in the conditions of 3-D space, skeletal decompression and what remains to be considered is the plasty of dura mater, and how it can be documented. The results of electrophysiological investigations in cervical myelopathy patients do not enable targeted surgery in patients with long stenoses, on the opposite side the 3-D reconstruction of both skeletal and spinal cord structures eliminates this disadvantage, as the surgical solution demonstrates.