İntraoperatif görüntüleme teknolojisi olmayan kliniklerde üst servikal enstrümantasyon gereken olgularda navigasyon kullanımı
Year 2023,
, 285 - 290, 31.12.2023
Ahmet Karaoglu
,
Turgut Kuytu
Abstract
Enstrümantasyon gerektiren üst servikal omurga cerrahisi, hem bölgedeki kritik yapıların varlığı hem de değişken pedikül anatomisi nedeniyle oldukça karmaşık bir işlemdir. Vida malpozisyonunu ve kritik sinir ve damar yapılarının yaralanmasını önlemeyi amaçlayan intraoperatif görüntüleme ve navigasyon teknolojileri gibi teknolojik gelişmeler yaygın olarak kullanılmasına rağmen, bu teknolojileri kullanabilen sadece birkaç klinik bulunmaktadır. Üst servikal omurganın enstrümantasyonuna yardımcı olan intraoperatif görüntüleme olanaklarının bulunmadığı kliniklerde, bu yazıda açıklanan tekniğin yardımıyla navigasyon teknolojisi hem posterior hem de anterior yaklaşımlarda kullanılabilir. Bu yaklaşım, serbest el yöntemine kıyasla komplikasyon oranlarını azaltmakla kalmayacak, aynı zamanda hem hasta hem de cerrahi ekip için radyasyon maruziyetini önemli ölçüde azaltacaktır.
References
- 1. Zhao J, Yang L, Zheng S, Qu Y, Zhang X, Kang M, Dong R, Zhao X, Yu T. A novel screw view model of 3D navigation for upper cervical pedicle screw placement: A case report. Medicine (Baltimore). 2019;98(19):e15291. doi: 10.1097/MD.0000000000015291.
- 2. Bydon M, Mathios D, Macki M, et al. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Clin Neurol Neurosurg 2014;125:24–7. doi: 10.1016/j.clineuro.2014.07.017.
- 3. Pham MH, Bakhsheshian J, Reid PC, et al. Evaluation of C2 pedicle screw placement via the freehand technique by neurosurgical trainees. J Neurosurg Spine 2018;29:235–240. doi: 10.3171/2018.1.SPINE17875.
- 4. Punyarat P, Buchowski JM, Klawson BT, et al. Freehand technique for C2 pedicle and pars screw placement: is it safe? Spine J 2018;18:1197–1203. doi: 10.1016/j.spinee.2017.11.010.
- 5. Ondra SL, Marzouk S, Ganju A, et al. Safety and efficacy of C2 pedicle screws placed with anatomic and lateral C-arm guidance. Spine (Phila Pa 1976) 2006;31:E263–7. doi: 10.1097/01.brs.0000214882.34674.be.
- 6. Li L, Yu X, Wang P, Chen L. Analysis of the treatment of 576 patients with congenital craniovertebral junction malformations. J Clin Neurosci 2012;19: 49–56. doi: 10.1016/j.jocn.2011.03.036.
- 7. Grob D, Magerl F. Surgical stabilization of C1 and C2 fractures. Orthopade 1987;16: 46–54. PMID: 3574943.
- 8. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001;26: 2467–2471. doi: 10.1097/00007632-200111150-00014.
- 9. Sim HB, Lee JW, Park JT, Mindea SA, Lim J, Park J. Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976) 2011;36: E401–E407. doi: 10.1097/BRS.0b013e31820611ba.
- 10. Tian W, Liu YJ, Liu B, He D, Wu JY, Han XG, et al. Technical Committee on Medical Robot Engineering of Chinese Society of Biomedical Engineering; Technical Consulting Committee of National Robotic Orthopaedic Surgery Application Center. Guideline for Posterior Atlantoaxial Internal Fixation Assisted by Orthopaedic Surgical Robot. Orthop Surg 2019;11(2):160-166. doi: 10.1111/os.12454.
- 11. Uchino A, Saito N, Watadani T, et al. Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 2012;54(1):19-23. doi: 10.1007/s00234-011-0849-z.
- 12. Lall R, Patel NJ, Resnick DK. A review of complications associated with craniocervical fusion surgery. Neurosurgery 2010;67:1396–1402. doi: 10.1227/NEU.0b013e3181f1ec73.
- 13. Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663–74. PMID: 4434035
- 14. Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 1997;22:1843–52. doi: 10.1097/00007632-199708150-00009.
- 15. Hsu WK, Anderson PA. Odontoid fractures: update on management. J Am Acad Orthop Surg 2010;18:383–94. doi: 10.5435/00124635-201007000-00001.
- 16. Shousha M, Alhashash M, Allouch H, Boehm H. Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl-Gallie technique. Eur Spine J 2019 Mar 16. doi: 10.1007/s00586-019-05946-x.
- 17. Kuytu T, Karaoglu A, Celik M, Aydemir F, Ozpar R, Tuzun Y. Can The Fracture Line of Type II Odontoid Fractures Come to A Neutral Position After Anterior Odontoid Screw Fixation without a Manipulation? Turk Neurosurg 2022;32(5):793-801. doi: 10.5137/1019-5149.JTN.36245-21.2.
- 18. Kotheeranurak V, Pholprajug P, Jitpakdee K, Pruttikul P, Chitragran R, Singhatanadgige W, Limthongkul W, Yingsakmongkol W, Kim JS. Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique. Orthop Surg. 2022 14(5):990-996. doi: 10.1111/os.13271.
- 19. Navarro-Ramirez R, Lang G, Lian X, et al. Total Navigation in Spine Surgery; A Concise Guide to Eliminate Fluoroscopy Using a Portable Intraoperative Computed Tomography 3-Dimensional Navigation System. World Neurosurg 2017;100:325-35. doi: 10.1016/j.wneu.2017.01.025.
- 20. Kirnaz S, Gebhard H, Wong T, Nangunoori R, Schmidt FA, Sato K, Härtl R. Intraoperative image guidance for cervical spine surgery. Ann Transl Med. 2021;9(1):93. doi: 10.21037/atm-20-1101.
- 21. Takamatsu N, Manabe H, Yokoo Y, Wada K, Hirano T, Hibino N, Henmi T, Chikawa T, Sairyo K. Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury. J Med Invest 2022;69(3.4):273-277. doi: 10.2152/jmi.69.273.
- 22. Bratschitsch G, Leitner L, Stücklschweiger G, Guss H, Sadoghi P, Puchwein P, Leithner A, Radl R. Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery. Sci Rep 2019;9(1):17652. doi: 10.1038/s41598-019-53472-z.
Using navigation in cases requiring upper cervical instrumentation in clinics without intraoperative imaging technology
Year 2023,
, 285 - 290, 31.12.2023
Ahmet Karaoglu
,
Turgut Kuytu
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.
Ethical Statement
Etik kurul raporu gerekmemektedir.
makale teknik not kategorisindedir.
Supporting Institution
yok
References
- 1. Zhao J, Yang L, Zheng S, Qu Y, Zhang X, Kang M, Dong R, Zhao X, Yu T. A novel screw view model of 3D navigation for upper cervical pedicle screw placement: A case report. Medicine (Baltimore). 2019;98(19):e15291. doi: 10.1097/MD.0000000000015291.
- 2. Bydon M, Mathios D, Macki M, et al. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Clin Neurol Neurosurg 2014;125:24–7. doi: 10.1016/j.clineuro.2014.07.017.
- 3. Pham MH, Bakhsheshian J, Reid PC, et al. Evaluation of C2 pedicle screw placement via the freehand technique by neurosurgical trainees. J Neurosurg Spine 2018;29:235–240. doi: 10.3171/2018.1.SPINE17875.
- 4. Punyarat P, Buchowski JM, Klawson BT, et al. Freehand technique for C2 pedicle and pars screw placement: is it safe? Spine J 2018;18:1197–1203. doi: 10.1016/j.spinee.2017.11.010.
- 5. Ondra SL, Marzouk S, Ganju A, et al. Safety and efficacy of C2 pedicle screws placed with anatomic and lateral C-arm guidance. Spine (Phila Pa 1976) 2006;31:E263–7. doi: 10.1097/01.brs.0000214882.34674.be.
- 6. Li L, Yu X, Wang P, Chen L. Analysis of the treatment of 576 patients with congenital craniovertebral junction malformations. J Clin Neurosci 2012;19: 49–56. doi: 10.1016/j.jocn.2011.03.036.
- 7. Grob D, Magerl F. Surgical stabilization of C1 and C2 fractures. Orthopade 1987;16: 46–54. PMID: 3574943.
- 8. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001;26: 2467–2471. doi: 10.1097/00007632-200111150-00014.
- 9. Sim HB, Lee JW, Park JT, Mindea SA, Lim J, Park J. Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976) 2011;36: E401–E407. doi: 10.1097/BRS.0b013e31820611ba.
- 10. Tian W, Liu YJ, Liu B, He D, Wu JY, Han XG, et al. Technical Committee on Medical Robot Engineering of Chinese Society of Biomedical Engineering; Technical Consulting Committee of National Robotic Orthopaedic Surgery Application Center. Guideline for Posterior Atlantoaxial Internal Fixation Assisted by Orthopaedic Surgical Robot. Orthop Surg 2019;11(2):160-166. doi: 10.1111/os.12454.
- 11. Uchino A, Saito N, Watadani T, et al. Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 2012;54(1):19-23. doi: 10.1007/s00234-011-0849-z.
- 12. Lall R, Patel NJ, Resnick DK. A review of complications associated with craniocervical fusion surgery. Neurosurgery 2010;67:1396–1402. doi: 10.1227/NEU.0b013e3181f1ec73.
- 13. Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663–74. PMID: 4434035
- 14. Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 1997;22:1843–52. doi: 10.1097/00007632-199708150-00009.
- 15. Hsu WK, Anderson PA. Odontoid fractures: update on management. J Am Acad Orthop Surg 2010;18:383–94. doi: 10.5435/00124635-201007000-00001.
- 16. Shousha M, Alhashash M, Allouch H, Boehm H. Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl-Gallie technique. Eur Spine J 2019 Mar 16. doi: 10.1007/s00586-019-05946-x.
- 17. Kuytu T, Karaoglu A, Celik M, Aydemir F, Ozpar R, Tuzun Y. Can The Fracture Line of Type II Odontoid Fractures Come to A Neutral Position After Anterior Odontoid Screw Fixation without a Manipulation? Turk Neurosurg 2022;32(5):793-801. doi: 10.5137/1019-5149.JTN.36245-21.2.
- 18. Kotheeranurak V, Pholprajug P, Jitpakdee K, Pruttikul P, Chitragran R, Singhatanadgige W, Limthongkul W, Yingsakmongkol W, Kim JS. Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique. Orthop Surg. 2022 14(5):990-996. doi: 10.1111/os.13271.
- 19. Navarro-Ramirez R, Lang G, Lian X, et al. Total Navigation in Spine Surgery; A Concise Guide to Eliminate Fluoroscopy Using a Portable Intraoperative Computed Tomography 3-Dimensional Navigation System. World Neurosurg 2017;100:325-35. doi: 10.1016/j.wneu.2017.01.025.
- 20. Kirnaz S, Gebhard H, Wong T, Nangunoori R, Schmidt FA, Sato K, Härtl R. Intraoperative image guidance for cervical spine surgery. Ann Transl Med. 2021;9(1):93. doi: 10.21037/atm-20-1101.
- 21. Takamatsu N, Manabe H, Yokoo Y, Wada K, Hirano T, Hibino N, Henmi T, Chikawa T, Sairyo K. Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury. J Med Invest 2022;69(3.4):273-277. doi: 10.2152/jmi.69.273.
- 22. Bratschitsch G, Leitner L, Stücklschweiger G, Guss H, Sadoghi P, Puchwein P, Leithner A, Radl R. Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery. Sci Rep 2019;9(1):17652. doi: 10.1038/s41598-019-53472-z.