Spinal navigation with preoperative computed tomography

Abstract

Safe placement of posterior cervical-sacral pedicle screws, S2-Ala-iliac screws, iliac screws, transarticular screws C1/2, translaminar screws C2 or cervical lateral mass screws under the guidance of spinal navigation. All posterior spinal instrumentations with screws: instabilities and deformities of rheumatic, 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 for spinal navigation. Cervical spine: Prone position on agel mattress, rigid head fixation, e.g., with Mayfield tongs; if appropriate, closed reduction under lateral image intensification; thoracic + lumbar spine: prone position on acushioned frame; 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 fusion is to be obtained, decortication of the posterior bone elements with ahigh-speed burr and onlay of cancellous bone or bone substitutes. In stable instrumentations, no postoperative immobilization with orthosis is necessary, removal of drains (if used) 2-3days postoperatively (postop), removal of the sutures 14days postop, clinical and x‑ray controls 3and 12months postop or in case of clinical or neurological deterioration. Numerous studies showed that the use of spinal navigation significantly reduces implant malplacement rates, complications, and revision surgery. Furthermore, intraoperative radiation exposure to the operation team can be reduced by up to 90%.