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Frameless stereotaxy and anterior cervical surgery
C Bolger1, C Wigfield, T Melkent
1Department of Neurosurgery, Frenchay Hospital, Bristol, United Kingdom. cbolger@neurosurgery.demon.co.uk
Summary
Frameless image guidance systems can now be used for anterior cervical spine surgery. A novel tracking device improved registration accuracy, enabling precise placement of screws and identification of resection margins in cervical spondylosis patients.
Area of Science:
- Neurosurgery
- Medical Imaging
- Orthopedic Surgery
Background:
- Anterior cervical spine surgery presents challenges for image guidance due to limited fixed anatomical landmarks.
- Accurate three-dimensional (3D) image registration is crucial for navigation in these procedures.
Purpose of the Study:
- To evaluate the efficacy of a frameless image guidance system in anterior cervical surgery for cervical spondylosis.
- To address challenges in 3D image registration using a novel tracking device.
Main Methods:
- Preoperative CT scans were obtained and reconstructed for image guidance.
- A novel registration tracking device was attached to a modified Caspar retractor.
- Point matching and surface mapping techniques were employed for image registration.
Main Results:
- Initial attempts at registration were unsuccessful in 7 patients.
- Registration time was prolonged in 5 patients.
- Successful registration with high accuracy (0.74 +/- 0.4 mm) was achieved in 28 patients, enabling precise screw placement and margin identification.
Conclusions:
- Frameless stereotaxy is feasible for anterior cervical spine procedures.
- The system offers benefits in accurate anatomical definition, resection margin visualization, and intraoperative guidance.
- This technique is particularly valuable for complex or disrupted cervical spine anatomy.