Intraoperative portable CT-scanner based spinal navigation - a feasibility and safety study

Abstract

Navigation based on an intraoperative CT scan is not a new approach to spinal instrumentation. Innovative intraoperative imaging technology, however, opens new horizons to more precise image acquisition as well as to further workflow. Planning of screw entry-points and trajectories in this study had been based on intraoperative imaging obtained by a portable 32-slice CT scanner. This prospective study evaluates feasibility, accuracy, and safety of this novel approach in an initial series of 85 surgeries. Medical records and radiological materials of 82 patients who underwent the first 85 consecutive stabilisations were analysed. Incorrect screw position, medical and technical complications as well as availability of this procedure in particular spinal levels were the subject of evaluation. Out of 571 implants inserted in all spinal levels, only five screws (0.87 %) did not meet the criteria for correct implant position. These screw misplacements had not been complicated by neural, vascular or visceral injury and the surgeon was not forced to change the position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging sufficient for navigation was obtained at all spinal segments regardless of a patient's habitus or positioning or comorbidity. Intraoperative portable CT scanner-based navigation seems to be an effective way of doing spinal instrumentation guidance. High precision of implant insertion confirms the preconditions of navigation usage during more complex surgeries at any level of the spine.