Introduction: Stabilization of posterior c-spine typically achieved by lateral mass screws (LMS). The use of 3D navigation may help in identifying the ideal trajectory. the use of navigation for LMS has not been fully investigated. The purpose of this study to show if there is any difference observed in terms of complications whether using the 3D navigation system or using the freehand technique
Methods: a prospective study was performed for a total of 40 consecutive patients. in Twenty patients the 3D navigation system was uesd while the other twenty had their LMS inserted by the traditional technique. Ethics approval was obtained for this study. demographic data were compared between the two groups. intraoprative events ( spinal cord injury, vertebral artery injury, root injury etc ) were captured and all patients had post-operative CT scan for assessment of screws positions, lateral mass fractures, rod breakage and screws lessening. Means and SD were calculated . Events proportions were calculated and outcomes were compared between the two groups using Z test. all statistical test were calculated at alpha level of 5%.
Results: A total of 285 LMS inserted in 40 patients.The mean age for patients who underwent navigation was 62.4 (CI 5.6) while for the other group it was 64.6 (CI3.7). There was no statistical difference between the two groups in regard to their demographic data. Screws malposition was statistically different between the two groups p 0.01 ( 19% within the standard group and was only 3.5% within the navigation group).there was no statistical differences in regard to the incidence of vertebral artery injury, SC injury ,nerve root injury or hospital stay. Intraoprative LM fractures were higher in the standard group.
Conclusions: The use of 3D navigation in LMS insertion will decrease the rate of screw malposition ( facet, foramen transversarium).This may reduce the surgical complications and improve the patients outcome
Patient Care: by increase neurosurgeons awareness about an effective method to reduce possible operative complications
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of reducing complications with LMS insertion
2) Identify an effective method to reduce possible operative complications