Standard navigation versus intraoperative computed tomography navigation in upper cervical spine trauma

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Imaging

Background:

• C1-C2 fractures require precise surgical fixation.
• Standard navigation relies on preoperative imaging, which may not account for intraoperative changes.
• Intraoperative imaging offers real-time guidance for improved accuracy.

Purpose of the Study:

• To compare the accuracy, workflow, and radiation exposure of standard navigation versus intraoperative computed tomography (iCT) guidance for C1-C2 fracture surgery.
• To evaluate the effectiveness of iCT in screw placement for C1-C2 fractures.

Main Methods:

• Retrospective analysis of 16 patients with C1-C2 trauma undergoing surgery by a single surgeon.
• Comparison between standard navigation (n=7) using preoperative data and iCT guidance (n=9) with automatic registration.
• Screw placement accuracy assessed by iCT or postoperative CT; radiation doses quantified using dose length and area products.

Main Results:

• No screw misplacements occurred with iCT guidance, unlike standard navigation which had 15.38% grade 1 and 3.8% grade 2 deviations in C2 screws.
• Mean operating time was reduced with iCT (157.11 min) compared to standard navigation (186.57 min).
• Total effective radiation dose was higher in the iCT group (2.129 mSv) than the standard navigation group (1.129 mSv), but iCT protocols resulted in lower exposure than standard diagnostic neck CT.

Conclusions:

• Intraoperative computed tomography (iCT) navigation enhances accuracy and shortens operating times for C1-C2 fracture surgery.
• iCT is a safe and effective procedure that can reduce radiation exposure for surgical staff.
• Modified iCT scan protocols lead to lower radiation doses than conventional diagnostic CT scans of the neck.