title: Intraoperative Iso-C C-arm navigation in cervical spinal surgery: review of the first 52 cases.
abstract: METHODS
  Fifty-two study participants underwent cervical spine surgery using intraoperative Iso-C imaging with or without spinal navigation.
  
  
  OBJECTIVE
  To evaluate prospectively the feasibility, advantages, limitations, and applications of Iso-C in cervical spine surgery.
  
  
  BACKGROUND
  Existing stereotactic spinal navigational systems images must be acquired before surgery and typically require cumbersome point-to-point registration. Intraoperative computed tomography (CT) and magnetic resonance imaging (MRI) provide real-time information but can restrict access to the patient, preclude the use of traditional operating room tables, and are time-consuming. The Iso-C allows quick, CT-quality, real-time data acquisition without restricting access to the patient. The data acquired can be automatically transferred to navigational systems with the immediate ability to navigate for anterior or posterior cervical spine procedures.
  
  
  METHODS
  High-resolution isotropic three-dimensional data sets were acquired using the Iso-C intraoperative fluoroscopy in 52 cervical spine cases. In 30 cases, the data were imported automatically to the StealthStation Treon to support neuronavigation. In 22 cases, a postprocedural intraoperative CT was obtained with the Iso-C primarily to assess the extent of osseous decompression and/or the accuracy of implants or instrumentation. In most cases, a postoperative high-resolution CT image was obtained and compared with the Iso-C data.
  
  
  RESULTS
  Successful automated registration suitable for navigation was attained for all anterior and posterior cervical spinal cases. The postprocedural intraoperative Iso-C data were 100% concordant with those of postoperative high-resolution CT as determined by a blinded neuroradiologist.
  
  
  CONCLUSIONS
  Iso-C intraoperative fluoroscopy is an accurate and rapid way to perform CT-quality image-guided navigation in cervical spinal surgery. In most cases, it obviates the need for postoperative imaging.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Hott
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Papadopoulos
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Dickman
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation*; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome