Abstract
Introduction: Precise targeted excision of the C5–C6 osteoid osteoma with placement of reference array on clavicle with minimal disturbance of anatomy and motion.Methods: A 20-year-old male presented with an osteoid osteoma in the superior end plate of the C6 vertebra abutting the spinal canal causing intractable pain. The authors curetted the nidus using a 3D C-arm-based intraoperative scan integrated with an optical navigation system through a minimal access anterior cervical exposure. The patient reference array was affixed to the left clavicle using a threaded pin.Results: The postoperative CT-scan revealed complete excision. Follow-up MRI and CT after 12 months revealed C5–C6 intervertebral disc to be intact without evidence of any tumor recurrence. VAS for neck pain improved from 8/10 to 2/10 immediately postoperatively and 0/10 at 1 year follow-up with no limitation of cervical movement. A motion segment was preserved with this technique.Conclusions: Navigation allowed safe curettage of the nidus with minimal disturbance to the anatomy and motion. The site of attachment of patient reference array on clavicle can be recommended as stable, meeting all the criteria for optimal accuracy and stability.
Highlights
Cervical spine accounts for 26.8% of all spinal osteoid osteomas
Surgical excision is recommended for patients unresponsive to anti-inflammatory drugs [1,2]
The authors report the first description of a technique of excision of an osteoid osteoma of the C6 body proximal to the spinal cord as well as the superior end plate using intraoperative navigation
Summary
Cervical spine accounts for 26.8% of all spinal osteoid osteomas. Surgical excision is recommended for patients unresponsive to anti-inflammatory drugs [1,2]. The authors report the first description of a technique of excision of an osteoid osteoma of the C6 body proximal to the spinal cord as well as the superior end plate using intraoperative navigation. A 20-year-old male with a 2-year history of neck pain of progressively increasing severity had been resilient to NSAIDs. CT scan showed an oval osteolytic lesion with ossified nidus and surrounding sclerosis suggestive of an osteoid osteoma at the right posterosuperior corner of C6 vertebral body abutting the superior end plate and close to the spinal cord. A plan of intraoperative 3D C-arm-based navigation was finalized (Stealth-Station S7, Medtronic; SIEMENS Arcadis Orbic 3D C-arm) for precise location and excision of the lesion with preservation of adjacent disc and cervical mobility (Figure 2). Follow-up flexion and extension X-rays at 1 year show stability and preservation of the motion segment (Figure 7)
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