Navigation Assistance in Orthopedic Oncosurgery: Our Early Experience

The primary objective of orthopedic oncologists is to perform bone tumor surgeries with tumor-free margins for malignant tumors and complete clearance of benign bone diseases. The functional outcome depends on the salvage of important structures and optimal reconstruction of the bony defect. On-going advances in technology have helped in 3-dimensional templating of patient's anatomy and real-time tracking of instruments during surgery. Computer navigation system joins patients' imaging information to real-time anatomy by using tracking and registration of pre- and/or intra-operative acquired images. We share our experience with 15 navigation-assisted surgeries performed at a single institute. We used BrainLab navigation system coupled with the Ziehm vision RFD 3D C-arm for intra-op registration in our cases. Our study did not compare the accuracy of the resection with the intended plan using imaging in all cases; however, margins were negative in all malignant cases. These patients were followed up for a short period. Multicenter comparative studies with longer follow-ups are required to establish their clinical effectiveness. Current evidence suggests that this technology may be applicable in challenging anatomical locations and joint/physis preserving tumor surgery to achieve precise resections or curettages that accurately match intended resection plans.