title: The use of intraoperative navigation for complex upper cervical spine surgery.
abstract: Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2-3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1-2 with distortion of the anatomy and overgrowth of the bony structure at C-2.
authors.affiliation: Department of Neurosurgery, Kaiser Permanente Medical Group, Sacramento, California; and Department of Neurosurgery, University of California, San Francisco, California.
authors.forename: Kern H
authors.initials: KH
authors.lastname: Guppy
authors.forename: Indro
authors.initials: I
authors.lastname: Chakrabarti
authors.forename: Amit
authors.initials: A
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D013123:Spinal Fusion / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods