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  • Assessment of Spinal Column Stability for Image-Guidance After Lateral Corpectomy

    Final Number:
    1642

    Authors:
    Jerald Redmond PhD; Ripul R. Panchal DO, FACS; Julien Prevost; Daniel Woods

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Lateral corpectomies are well-established procedures for treatment of common spinal pathologies. Image-guidance provides enhanced visualization for procedural accuracy; however, accuracy depends on anatomical stability relative to the patient reference. A cadaveric study was conducted to evaluate vertebral body stability following partial and full corpectomies.

    Methods: Two cadavers were prepped in the right decubitus position per typical clinical setup. Thoracic and lumbar access was performed for one cadaver, with lumbar access only for the second. Bolt holes were prepped to simulate lateral plating, followed by placement of two fiducials each in the superior and inferior bodies above and below the planned corpectomy levels (Centerpiece Screws; Medtronic PLC, Dublin, Ireland). 3D imaging was performed to establish the pre-procedure state of the anatomy (O-arm, Medtronic PLC), followed by partial and full corpectomies, with additional scans taken after each procedure. Image data was post-processed with Mimics (Materialise, Leuven, Belgium) to segment the fiducials. 3D models of the fiducials were exported to Geomagic (3D Systems, North Carolina, USA) to assess displacement of the vertebral bodies and relative shift of fiducials with respect to the pre-procedure state.

    Results: Displacement between fiducials on the same body showed a maximum of 0.31 mm, representing error of the 3D reconstruction. Displacement between fiducials on different bodies showed a maximum of 1.58 mm. Relative shift of the fiducials after registration showed a maximum of 1.42 mm. The maximum for both displacement and shift were observed between the pre-procedure and post-full corpectomy states.

    Conclusions: The results show minimal change in position after both partial and full corpectomies in a cadaveric model, indicating spinal column stability despite significant bone removal. This observed stability is associated with maintenance of facet joints and posterior ligamentous structures, demonstrating capability for procedural accuracy with image-guidance.

    Patient Care: This research will help inform surgeons and practitioners of appropriate workflows and procedural techniques for use of image guidance during lateral corpectomy procedures.

    Learning Objectives: By the conclusion of this session, participants should be able to understand workflows and applications for use of image-guidance in lateral corpectomy procedures.

    References:

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