OBJECTIVE Spinal navigation techniques for surgical fixation of unstable C1-2 pathologies are challenged by complex osseous and neurovascular anatomy, instability of the pathology, and unreliable preoperative registration techniques. An intraoperative CT scanner with autoregistration of C-1 and C-2 promises sufficient accuracy of spinal navigation without the need for further registration procedures. The aim of this study was to analyze the accuracy and reliability of posterior C1-2 fixation using intraoperative mobile CT scanner-guided navigation. METHODS In the period from July 2014 to February 2016, 10 consecutive patients with instability of C1-2 underwent posterior fixation using C-2 pedicle screws and C-1 lateral mass screws, and 2 patients underwent posterior fixation from C-1 to C-3. Spinal navigation was performed using intraoperative mobile CT. Following navigated screw insertion in C-1 and C-2, intraoperative CT was repeated to check for the accuracy of screw placement. In this study, the accuracy of screw positioning was retrospectively analyzed and graded by an independent observer. RESULTS The authors retrospectively analyzed the records of 10 females and 2 males, with a mean age of 80.7 ± 4.95 years (range 42-90 years). Unstable pathologies, which were verified by fracture dislocation or by flexion/extension radiographs, included 8 Anderson Type II fractures, 1 unstable Anderson Type III fracture, 1 hangman fracture Levine Effendi Ia, 1 complex hangman-Anderson Type III fracture, and 1 destructive rheumatoid arthritis of C1-2. In 4 patients, critical anatomy was observed: high-riding vertebral artery (3 patients) and arthritis-induced partial osseous destruction of the C-1 lateral mass (1 patient). A total of 48 navigated screws were placed. Correct screw positioning was observed in 47 screws (97.9%). Minor pedicle breach was observed in 1 screw (2.1%). No screw displacement occurred (accuracy rate 97.9%). CONCLUSION Spinal navigation using intraoperative mobile CT scanning was reliable and safe for posterior fixation in unstable C1-2 pathologies with high accuracy in this patient series.

译文

目的脊柱导航技术用于手术固定不稳定的C1-2病理受到复杂的骨和神经血管解剖,病理的不稳定性以及不可靠的术前配准技术的挑战。具有C-1和C-2自动注册的术中CT扫描仪保证了脊柱导航的足够准确性,而无需进一步的注册程序。这项研究的目的是分析使用术中移动CT扫描仪引导的导航进行后路C1-2固定的准确性和可靠性。方法2014年7月至2016年2月连续10例C1-2不稳患者采用C-2椎弓根螺钉和C-1侧块螺钉进行后路固定,C-1至C-3 2例后路固定。使用术中移动CT进行脊柱导航。在C-1和C-2中导航螺钉插入后,重复术中CT以检查螺钉放置的准确性。在这项研究中,由独立的观察者对螺钉定位的准确性进行了回顾性分析和评分。结果作者回顾性分析了10名女性和2名男性的记录,平均年龄为80.7 ± 4.95岁 (42-90岁)。通过骨折脱位或屈伸x线片证实的不稳定病理包括8例安德森II型骨折,1例不稳定安德森III型骨折,1例hangman骨折Levine Effendi Ia,1例复杂hangman-Anderson III型骨折和1例破坏性C1-2类风湿性关节炎。在4例患者中,观察到重要的解剖结构: 高位椎动脉 (3例) 和关节炎引起的C-1侧块的部分骨性破坏 (1例)。总共放置了48个导航螺钉。在47个螺钉 (97.9%) 中观察到正确的螺钉定位。在1个螺钉 (2.1%) 中观察到轻微的椎弓根破裂。没有螺杆位移发生 (准确率97.9%)。结论在不稳定的C1-2病变中,使用术中移动ct扫描进行脊柱导航是可靠且安全的,在该系列患者中准确性较高。

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