Using navigation in cases requiring upper cervical instrumentation in clinics without intraoperative imaging technology

Abstract

Upper cervical spine surgery which requires instrumentation is a highly complicated procedure, both due to the presence of critical structures in the region and variable pedicle anatomy. Despite the widespread use of technological advances as intraoperative imaging and navigation technologies aimed at preventing screw malposition and injuries to the critical neural and vascular structures, there are only a few clinics capable of employing those technologies. In clinics lacking intraoperative imaging facilities that assist in the instrumentation of the upper cervical spine, navigation technology can be employed in both posterior and anterior approaches with the assistance of the technique described in this manuscript. This approach will not only decrease complication rates compared with the freehand method, but also considerably lower radiation exposure for both the patient and surgical team.