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[Intraoperative computed tomography-guided navigation for implant anchorage in spine surgery].

OBJECTIVE: Improved accuracy of spinal instrumentation with the use of intraoperative CT (iCT).

INDICATIONS: All types of posterior spinal instrumentation.


SURGICAL TECHNIQUE: After fixation of the spinal clamp, an intraoperative CT (iCT) is performed. The image data set can then be used for navigation of the spinal implants. The arrangement of the devices, positioning of the patient, and the exact fixation of the clamp depend on the operation technique and the anatomical region. A high level of standardization is necessary for clinical success. In general, the utilization of drill guides over the use of awls and Yamshidi needles is strongly recommended. Thereby the risk of segmental vertebral rotation, especially in multisegmental instrumentation, will be reduced.

POSTOPERATIVE MANAGEMENT: The postoperative management depends on the type of surgery and is not influenced by the use of navigation with iCT.

RESULTS: In our patient group of the first 200 surgeries with iCT (AIRO, Brainlab AG, Munich, Germany), we performed 34% cervical instrumentations, 31% percutaneous screw insertions, and 35% multisegmental open procedures including the sacrum or ilium. Two surgeries had to be converted to conventional technique due to technical problems. One misplaced S2/Ala/ilium screw had to be corrected in revision surgery. The infection rate was 2.5% and was not increased compared to conventional procedures. In the literature, a significant reduction of radiation exposure was shown, when iCT and navigation were used. Also, in longer surgical cases the operation time could be reduced. In comparison with 3D C‑arm imaging, the image quality and screw accuracy is improved by iCT. Due to the possibility of 3D intraoperative implant control, the number of revision cases can be reduced.

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