Spinal navigation for posterior cervical and cervicothoracic instrumentation

Abstract

Safe placement of posterior cervical or high-thoracic pedicle screws, transarticular screws C1/2, translaminar screws C2 or cervical lateral mass screws under the guidance of spinal navigation. All posterior cervical and cervicothoracic instrumentation with screws: instabilities and deformities of rheumatoid, traumatic, neoplastic, infectious, iatrogenic or congenital origin; multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment. There are no absolute contraindications. Prone position on agel mattress, rigid head fixation, e.g., with Mayfield tongs; if appropriate, closed reduction under lateral image intensification; midline posterior surgical approach at the level of the segments to be instrumented; if necessary, open reduction; insertion of the cervical/upper thoracic screws under the guidance of spinal navigation; if necessary, posterior decompression; instrumentation longitudinal rods; if afusion is to be obtained, decortication of the posterior bone elements with ahigh-speed burr and onlay of cancellous bone or bone substitutes. In stable instrumentation, no postoperative immobilization with cervical collar is necessary. Drain removal on postoperative day2-3, suture removal on postoperative day14, clinical and x‑ray control 3 and 12months after surgery or in case of clinical or neurological deterioration. Numerous studies showed that the use of spinal navigation reduces implant malplacement rates significantly. Furthermore, it allows areduction of the radiation dose for the operation team up to 90%.