Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Abstract

The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision. The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors. From 2006 to 2009, we performed navigation-assisted surgery in 16 patients, 11 males and five females, with a mean age of 39 years (range, 13-70 years). We diagnosed nine benign bone tumors and seven malignant bone and soft tissue tumors. In two patients, the malignant soft tissue tumors infiltrated the adjacent bones. Nine excisional biopsies for benign tumors and seven en bloc excisions for malignant tumors were performed. In all cases, the point registration method was performed using 10 skin markers, which were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT. The mean accuracy of this system, which was determined using skin markers, was 0.93 mm (range, 0.6-1.2 mm). All biopsy and excision samples were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or excised histologic specimen was 0 mm to 4 mm. The mean followup was 34 months (range, 10-54 months). There were no local recurrences, except for excision of skip metastases in a patient with a chordoma. We report our experience with navigation-assisted surgery for bone and soft tissue tumors. Navigation-assisted surgery could be indicated for sufficiently reliable, accurate, and minimally invasive resections.