Anterior column reconstruction in thoracolumbar injuries utilizing a computer-assisted navigation system

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Anterior reconstruction of unstable thoracolumbar spine fractures involves technically demanding discectomy, corpectomy, and posterior wall fragment resection.
• These procedures require maximum surgical precision.

Purpose of the Study:

• To investigate the feasibility of computer-aided guidance for discectomy, corpectomy, and posterior wall fragment resection.
• To analyze the precision, advantages, and disadvantages of computer-aided guidance in these procedures.

Main Methods:

• A controlled clinical trial comparing computer-aided guidance (21 patients) versus conventional methods (10 patients).
• Surgical steps included discectomy, corpectomy, and cage interposition for anterior reconstruction, all under endoscopic assistance.
• Surgical precision was assessed by cage decentralization and endplate alignment; total surgery time was recorded.

Main Results:

• Surgery time was significantly longer in the computer-aided guidance group (3.8 ± 1.0 hours) compared to the control group (1.7 ± 0.5 hours).
• No statistically significant differences in cage decentralization or endplate alignment precision were found between the groups.
• A trend towards fewer cases of cage subsidence was observed in the computer-aided guidance group.

Conclusions:

• Computer-aided guidance is a technically feasible option for anterior reconstruction of the thoracolumbar spine, particularly for complex fragment resection.
• While it does not improve cage positioning precision, it may offer benefits in protecting adjacent endplates, indicated by a trend of reduced cage subsidence.
• The primary disadvantage identified is a significant prolongation of total surgical time.