[Spinal navigation for posterior cervical and cervicothoracic instrumentation].
OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019;
31:263-274. [PMID:
31197402 DOI:
10.1007/s00064-019-0610-z]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE
Safe placement of posterior cervical or high-thoracic pedicle screws, transarticular screws C1/2, translaminar screws C2 or cervical lateral mass screws under the guidance of spinal navigation.
INDICATIONS
All posterior cervical and cervicothoracic instrumentation with screws: instabilities and deformities of rheumatoid, traumatic, neoplastic, infectious, iatrogenic or congenital origin; multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment.
CONTRAINDICATIONS
There are no absolute contraindications.
SURGICAL TECHNIQUE
Prone position on a gel mattress, rigid head fixation, e.g., with Mayfield tongs; if appropriate, closed reduction under lateral image intensification; midline posterior surgical approach at the level of the segments to be instrumented; if necessary, open reduction; insertion of the cervical/upper thoracic screws under the guidance of spinal navigation; if necessary, posterior decompression; instrumentation longitudinal rods; if a fusion is to be obtained, decortication of the posterior bone elements with a high-speed burr and onlay of cancellous bone or bone substitutes.
POSTOPERATIVE MANAGEMENT
In stable instrumentation, no postoperative immobilization with cervical collar is necessary. Drain removal on postoperative day 2-3, suture removal on postoperative day 14, clinical and x‑ray control 3 and 12 months after surgery or in case of clinical or neurological deterioration.
RESULTS
Numerous studies showed that the use of spinal navigation reduces implant malplacement rates significantly. Furthermore, it allows a reduction of the radiation dose for the operation team up to 90%.
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