Introduction: Fixation of C1-2 is challenging surgical procedure because of the complex anatomy and the need for a high degree of accuracy to avoid complication. Intraoperative 3D image(O-arm) based navigation system reduced complications, such as vertebral artery injury. In this study, we compared the surgical outcomes during the cervical fixation with and without intraoperative navigation.
Methods: We retrospectively reviewed radiologic images of 26 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2016 at our institution. There were 11 degenerative cervical disease and 14 traumatic cases. A total 107 screws were used and the surgical procedures were as follows; C1 lateral mass screw (C-arm:n=30, O-arm: n=22), C2 pedicle screw(C-arm: n=26, O-arm: n=21), C2 lamina screw(C-arm:n=2, O-arm:n=1), 5 short pars screw screws were placed under a c-arm guide. Accuracy of screw position was determined as following; Grade 0 : screw inside the bone, perforation of the cortex by(Grade I:< 2mm, Grade II:from 2 to 4mm, Grade III : >4mm). We also classified screw malposition as grade 0,1: minor malposition, and grades 2,3: major malposition.
Results: The results of accuracy of screws positioning was summarized on table 1. In 1 cases, we confirmed the malposition of C2 pedicle screw and corrected the screw positon. There was no complications regarding vertebral artery injury and no new onset neurologic deficit developed in any of the patients.In two group, Accuracy of the screw position was acceptable, but there was no statistical significance. The operating time, EBL, fusion rate, also does not show statistical significance. (Table 2)
Conclusions: In two group, Accuracy of the screw position was acceptable.With intraoperative O-arm system, we could confirm the misposition of screw, and could correct the position of screw in the operation
Patient Care: We have evaluated the accuracy of intraoperative CT image based navigation guided C1-2 screw fixation. Another advantage is that after fixation -intraoperative CT scan could confirm the malposition during the procedure.
Learning Objectives: We recommend using the format, "By the conclusion of this session, participants should be able to: Identify an effectiveness of intraoperative CT image based navigation guided operation.