title: 3D-based navigation in posterior stabilisations of the cervical and thoracic spine: problems and benefits. Results of 451 screws.
abstract: BACKGROUND
  Navigated procedures in spinal surgery have been established due to an increasing demand for precision. Especially, 3D C-arms connected to navigation systems are being used more often and can be utilised intraoperatively for the planning and controlling of screw positions. This prospective study analyses our experiences with 3D-based navigation in posterior stabilisations in the cervical and thoracic spine.
  
  
  METHODS
  A 3D C-Arm (Ziehm Vision Vario 3D(®)) was connected to a navigation system (VectorVision, Brainlab(®)) and used for the placement of, in total, 451 screws among 67 patients. Of those, 14 patients had to undergo operations in the cervical and 53 in the thoracic spine. Postoperatively, the positioning was observed with computed tomography (CT).
  
  
  RESULTS
  The application time is approximately 6 min. In total, 354/451 (78.5%) screws could be inserted assisted with navigation, and 272/451 (60.3%) were controlled intraoperatively. Regarding the cervical spine, in 87.1% (61/70) of the screws, the navigation procedure was uneventful. The positioning of 63.2% (43/68) of the screws was checked intraoperatively. In the upper thoracic spine, 77% (293/381) could be placed with navigation and 59.6% (227/381) were controlled intraoperatively. Occasionally, the scanning setup was problematic. Correct placement was seen in 92.7% of screws; for the remaining screws, no revision was needed.
  
  
  CONCLUSIONS
  Intraoperative 3D imaging navigation for posterior spinal stabilisations is technically feasible and reliable in clinical use. The image quality depends on the individual bone density. With undisturbed visibility of the vertebral body, the reliability of 3D-based navigation is comparable to that of CT-based procedures. Additionally, it has the advantage of skipping the preoperative acquisition of data as well as the matching process, with reduced radiation doses.
authors.affiliation: Department for Traumatology, Plastic and Reconstructive Surgery, Spine Center, University of Leipzig, Leipzig, Germany. jan-sven.jarvers@medizin.uni-leipzig.de.
authors.forename: J-S
authors.initials: JS
authors.lastname: Jarvers
authors.affiliation: Department for Orthopaedic Surgery, Traumatology and Hand Surgery, Helios Klinik Borna, Borna, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Katscher
authors.affiliation: Department for Traumatology, Plastic and Reconstructive Surgery, Spine Center, University of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Franck
authors.affiliation: Department for Traumatology, Plastic and Reconstructive Surgery, Spine Center, University of Leipzig, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Glasmacher
authors.affiliation: Department for Traumatology, Plastic and Reconstructive Surgery, Spine Center, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Schwarzach, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Blattert
authors.affiliation: Department for Traumatology, Plastic and Reconstructive Surgery, Spine Center, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Josten
keywords: 3D navigation; Cervical and thoracic spine; Image-guided surgery
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