Motion preservation surgery: excision of juxta C5-C6 intervertebral disc osteoid osteoma using 3D C-arm based...

Precise targeted excision of the C5-C6 osteoid osteoma with placement of reference array on clavicle with minimal disturbance of anatomy and motion.

A 20-year-old male presented with an osteoid osteoma in the superior end plate of the C6 vertebra abutting the spinal canal causing intractable pain. The authors curetted the nidus using a 3D C-arm-based intraoperative scan integrated with an optical navigation system through a minimal access anterior cervical exposure. The patient reference array was affixed to the left clavicle using a threaded pin.

The postoperative CT-scan revealed complete excision. Follow-up MRI and CT after 12 months revealed C5-C6 intervertebral disc to be intact without evidence of any tumor recurrence. VAS for neck pain improved from 8/10 to 2/10 immediately postoperatively and 0/10 at 1 year follow-up with no limitation of cervical movement. A motion segment was preserved with this technique.

Navigation allowed safe curettage of the nidus with minimal disturbance to the anatomy and motion. The site of attachment of patient reference array on clavicle can be recommended as stable, meeting all the criteria for optimal accuracy and stability.