Utility of C arm aided, CT guided, and O arm navigation aids to surgically manage cases of spinal osteoblastoma over a decade

Abstract

BackgroundSpinal osteoblastoma needs surgical intervention, and over a decade with advancing technologies, different radiological aids have been utilized in the form of CT scan, fluoroscopy and O arm, but no study has compared its efficacy and outcomes. Here, in this case report of three cases, we have compared the intra- and post-operative course and effectiveness of three radiological modalities.Case presentationWe reviewed three surgically treated cases of spinal osteoblastoma with aid of different generation radiological modalities like C arm, CT scan and O arm navigation treated over a span of more than 10 years in single institute by same surgeon. These 3 cases were assessed and compared in terms of intraoperative parameters (image acquisition type, image display, scan time, bone image quality, real-time imaging, radiation exposure, surgical time, blood loss, complications and others) and post-operative parameters (recovery, recurrence and follow-up). First case managed with aid of C arm showed fluoroscopically acquired two-dimensional images, poor bone image quality; higher scan time-surgical time and blood loss with higher radiation exposure and no real-time imaging. Second case managed with aid of CT scan provided three-dimensional images, better bone image quality; lower surgical time and blood loss but increased transport time with minimum radiological exposure to surgeon and OT personnel with no real-time imaging. Third case managed with O arm navigation provided 3-dimensional images, best bone image quality; less surgical time and blood loss with minimum radiological exposure to surgeon and OT personnel with real-time imaging. Additionally, O arm navigation improved accuracy of tumor localization and intraoperative confirmation of complete tumor excision. Whereas all three cases showed no clinico-radiological signs of recurrence on subsequent follow-ups.ConclusionO arm navigation in terms of best bone image quality, accuracy, intraoperative confirmation of tumor excision, surgical time, blood loss and post-operative recovery makes it superior to others.