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[CT and fluoroscopy based navigation in pelvic surgery].

U Stöckle1, B König, K Schaser

  • 1Unfall- und Wiederherstellungschirurgie, Charité, Campus Virchow-Klinikum, Humboldt Universität zu Berlin. ulrich.stoeckle@charite.de

Der Unfallchirurg
|November 25, 2003
PubMed
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Computed tomography (CT)-based navigation offers precise outcomes in pelvic surgery, particularly for tumor resections and minimally displaced fractures. Fluoroscopy-based navigation is preferred for sacroiliac screw fixations in trauma and degenerative conditions.

Area of Science:

  • Orthopedic Surgery
  • Medical Imaging
  • Surgical Navigation

Background:

  • Computer tomography (CT)-based navigation, initially for spine surgery, has expanded to joint replacement, reconstructive, and tumor surgery due to precision and reduced radiation.
  • Pelvic surgery adaptation of CT-based navigation requires identical fragment positioning between CT and operation, or necessitates new data acquisition.

Purpose of the Study:

  • To evaluate the efficacy and indications of CT-based and fluoroscopy-based navigation in pelvic surgery.
  • To describe the techniques and clinical experience with these navigation methods in specific pelvic procedures.

Main Methods:

  • Review of clinical experience with CT-based navigation in five percutaneous screw fixations and three tumor resections in the pelvis.
  • Analysis of 36 percutaneous screw fixations in the pelvis using fluoroscopy-based navigation between June 2000 and December 2002, with postoperative X-ray and CT control.

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Main Results:

  • CT-based navigation demonstrated high precision in pelvic procedures.
  • In the fluoroscopy-based navigation group, 35 out of 36 screws were placed correctly; one screw showed anterior cortex perforation of the sacrum without neurological deficit.
  • Adequate image quality in fluoroscopy-based navigation is crucial for successful sacroiliac screw fixation.

Conclusions:

  • CT-based navigation is indicated for screw fixations in minimally displaced pelvic injuries or dysplasia and increasingly in tumor surgery.
  • Fluoroscopy-based navigation is the preferred method for sacroiliac screw fixations in traumatic or degenerative instabilities, especially when image updates are required.