Intraoperative computed tomography with an integrated navigation system in stabilization surgery for complex...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Imaging

Background:

• Craniovertebral junction malformation (CVJM) stabilization is challenging due to complex anatomy and critical neurovascular structures.
• Intraoperative computed tomography (iCT) and neuronavigation systems (NNS) offer potential solutions for improved surgical precision.

Purpose of the Study:

• To evaluate the workflow, feasibility, and clinical outcomes of iCT-guided navigation for complex CVJM stabilization.
• To assess the accuracy and safety of navigated screw placement in CVJM surgery.

Main Methods:

• A prospective study involving 23 patients with complex CVJM undergoing navigated stabilization procedures.
• Utilized a sliding gantry 40-slice CT scanner integrated with an NNS for real-time image guidance.
• Employed various fixation techniques including C1-C2 transarticular, C1 lateral mass/C2 pedicle, and occipitocervical fixation.

Main Results:

• 108 screws were accurately placed with 98.1% overall accuracy using NNS.
• No major vascular or neural complications occurred; only 2 minor pedicle perforations were managed intraoperatively.
• Significant clinical improvement was observed in 91.3% of patients (at least one Nurick grade improvement) within 3 months post-surgery.

Conclusions:

• iCT with integrated NNS is a feasible and beneficial tool for complex CVJM stabilization.
• Navigated techniques enhance control over screw placement in challenging craniovertebral anatomy.
• This approach leads to improved clinical outcomes and achieves stable bony fusion.