title: Resection of spinal column tumors utilizing image-guided navigation: a multicenter analysis.
abstract: OBJECTIVE The use of intraoperative stereotactic navigation has become more available in spine surgery. The authors undertook this study to assess the utility of intraoperative CT navigation in the localization of spinal lesions and as an intraoperative tool to guide resection in patients with spinal lesions. METHODS This was a retrospective multicenter study including 50 patients from 2 different institutions who underwent biopsy and/or resection of spinal column tumors using image-guided navigation. Of the 50 cases reviewed, 4 illustrative cases are presented. In addition, the authors provide a description of surgical technique with image guidance. RESULTS The patient group included 27 male patients and 23 female patients. Their average age was 61 ± 17 years (range 14-87 years). The average operative time (incision to closure) was 311 ± 188 minutes (range 62-865 minutes). The average intraoperative blood loss was 882 ± 1194 ml (range 5-7000 ml). The average length of hospitalization was 10 ± 8.9 days (range 1-36 days). The postoperative complications included 2 deaths (4.0%) and 4 radiculopathies (8%) secondary to tumor burden. CONCLUSIONS O-arm 3D imaging with stereotactic navigation may be used to localize lesions intraoperatively with real-time dynamic feedback of tumor resection. Stereotactic guidance may augment resection or biopsy of primary and metastatic spinal tumors. It offers reduced radiation exposure to operating room personnel and the ability to use minimally invasive approaches that limit tissue injury. In addition, acquisition of intraoperative CT scans with real-time tracking allows for precise targeting of spinal lesions with minimal dissection.
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; 
authors.forename: Rani
authors.initials: R
authors.lastname: Nasser
authors.affiliation: Departments of 2 Neurosurgery and.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; 
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nakhla
authors.affiliation: Departments of 2 Neurosurgery and.
authors.forename: Lutfi
authors.initials: L
authors.lastname: Al-Khouja
authors.affiliation: Orthopedics, Cedars-Sinai Medical Center, Los Angeles; and.
authors.forename: Earl
authors.initials: E
authors.lastname: Brien
authors.affiliation: Departments of 2 Neurosurgery and.
authors.forename: Eli M
authors.initials: EM
authors.lastname: Baron
authors.affiliation: Departments of 2 Neurosurgery and.|Orthopedics, Cedars-Sinai Medical Center, Los Angeles; and.
authors.forename: Terrence T
authors.initials: TT
authors.lastname: Kim
authors.affiliation: Departments of 2 Neurosurgery and.|Department of Neurosurgery, University of California, Davis, California.
authors.forename: J
authors.initials: J
authors.lastname: Patrick Johnson
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; 
authors.forename: Reza
authors.initials: R
authors.lastname: Yassari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: EBL = estimated blood loss; O-arm 3D imaging; OR = operating room; image guidance; intraoperative stereotactic navigation; spinal metastases; spinal tumor resection