Intraoperative Stereotactic Arteriography in Complex Cervical Spine Surgery
Luke Mugge1, Danielle D Dang1, Mateo Ziu2
1Department of Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA.
Cureus
|April 23, 2024
Summary
The O-arm imaging system enhances surgical visualization of spinal vascular anatomy, improving safety during complex cervical spine procedures for trauma and oncology. This technique aids in preventing iatrogenic injury.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Radiology
Background:
- Intra-operative navigation, including the O-arm system, has transformed spinal instrumentation.
- The O-arm's capability for axial plane imaging of the spine is underutilized for visualizing spinal vascular anatomy.
Observation:
- A retrospective review of two cases: a Jefferson fracture and a C4-C7 epidural lesion.
- Vascular access was obtained via femoral and radial arteries, respectively.
- Intra-arterial contrast injection prior to O-arm imaging visualized critical vertebral arteries.
Findings:
- The O-arm facilitated clear visualization of vertebral arteries in relation to spinal pathology (fracture, tumor).
- In the first case, vertebral arteries were stretched near a mobile bony segment.
- In the second case, a vertebral artery was encased in tumor, posing an iatrogenic risk.
Implications:
- This approach offers improved intra-operative visualization of spinal vascular anatomy during complex cervical spine surgeries.
- It demonstrates the potential of the O-arm, combined with angiography, to enhance surgical planning and safety in spinal trauma and oncology.
- This technique may reduce the risk of vertebral artery injury in challenging surgical cases.
