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Intraoperative Navigation Good Tool for Spinal Stabilization Surgery

Posted on: 12/31/2009
Technology is changing the world and medicine is no different. As new applications are discovered and refined, they are finding their ways into medical and surgical treatments, making the treatments more reliable and with more favorable outcomes. The authors of this study wanted to see how image-guided spinal navigation with a computed tomography scanner (CT scan) could improve the safety and accuracy of spinal stabilization surgery.

To do the study, researchers looked at the data of 94 patients who had undergone surgery to stabilize the mid to lower part of the back (thoracolumbar) or the upper part (cervicothoracic). All patients had the surgery done along with computed tomography so the surgeons could have images of the spine, even after the screws were inserted.

The results of the study showed that adding CT scans to the surgery procedure added an average of 14 minutes to the length of time it took. Among the 94 surgeries, there were 216 scans. One hundred were done before the surgery and 116 during the surgery. This works out to 70 patients had two scans, 20 patients had three scans, and four patients had four scans.

The scans did show 20 screws, out of a total of 414 among all patients, were off by about 2 millimeters in placement. In 65 screws, there was a bit of perforation of less than 2 mm. In four cases, it was 2 mm or more.

For eight patients, the CT scan images affected how the surgery proceeded, with the surgeon correcting 10 of the screws right away. In some surgeries, where there were tumors, the CT scan was used to see if the tumor tissue had been removed successfully.

Repeat surgeries was at an 8.5 percent rate (four wound infections, two fistulas (tunnels in the tissue), and two epidural hematomas (collection of blood in the epidural space of the spine). The stabilization surgery was not the first one for two of the patients who had wound infections. A third patient with infection was an insulin-dependent diabetic. None of the repeat surgeries had to be done because of the screws.

Two patients experienced passing neurologic (nerve) complications within three months of the surgery.

The researchers also looked at 182 patients (781 screws) who had similar surgery done without CT scans in surgery. The results of those surgeries showed that 10.4 percent had to have repeat surgeries, with 4.4 percent needing the screws to be moved because they were not in the proper place. The average amount of time between the original surgery and the revision surgery was 52.6 days, although the days ranged from one day after surgery to 225 days after.

The authors concluded that the navigation available through CT scans is easy and rapid to perform, and results in good outcomes for patients undergoing spinal stabilization surgery. The scans do not interfere with the operating time and can be installed into an operating room without special equipment.

References:
Stefan Zausinger, MD, et al. Intraoperative Computed Tomography With Integrated Navigation System in Spinal Stabilizations. Spine. Dec 15, 2009. Vol. 34, No. 26. Pp. 2919 to 2926.

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