Stellenwert der Navigation

Abstract

Importance of Navigation Navigation and intraoperative imaging have undergone an enormous development in recent years. By using intraoperative navigation, the precision of pedicle screw implantation can be increased in the sense of patient safety. Especially in the case of complex defects or tumor diseases, navigation is a decisive aid. As a result of the constantly improved technology, the requirements for reduced radiation exposure and intraoperative control can also be met. The high costs of the devices can be amortized, for example by a reduced number of revisions. This overview presents the principles of navigation in spinal surgery and the advantages and disadvantages of the different navigation procedures.

In dieser Übersichtsarbeit werden die Prinzipien der Navigation in der Wirbelsäulenchirurgie und deren Stellenwert mit den Vor- und Nachteilen der verschiedenen Navigationsverfahren dargestellt. Durch die Anwendung der intraoperativen Navigation kann die Präzision der Pedikelschraubenimplantation und damit die Patientensicherheit erhöht werden. Auch bei komplexen Fehlstellungen oder Tumorerkrankungen leistet die Navigation eine entscheidende Hilfe.

Fazit

• Die Präzision von Pedikelschrauben kann durch die Navigation verbessert werden.

• Nach einer anfänglichen Lernkurve kann die Operationszeit vermindert werden.

• Durch Navigation kann vor allem beim Personal eine Strahlenreduktion erreicht werden.

• Den hohen Kosten der Anschaffung müssen die erhöhte Sicherheit und die Reduktion von Revisionsoperationen entgegengehalten werden.

• Die intraoperative Schraubenkontrolle in allen Ebenen ist der große Vorteil der Verfahren

  • iCT ( = intraoperativ angefertigte Computertomografie),

  • 3D-C-Arm,

  • Flachdetektor-gestützte Verfahren.

• Gerade bei komplexen Eingriffen kann die Navigation hilfreich sein.

• Die Navigation stellt mitnichten eine Absicherung des Unerfahrenen dar, sondern ist ein fortgeschrittenes Modul in der Hand des Erfahrenen.

• Der Operateur muss jederzeit in der Lage sein, die Operation auch ohne diese technischen Hilfsmittel zu Ende zu bringen.

Schlüsselwörter

Wirbelsäulenchirurgie - intraoperative Bildgebung - 3D-C-Bogen - Flachdetektor - Pedikelschrauben - intraoperatives CT

Keywords

spine surgery - intraoperative imaging - 3 D C-arm - flatpanel - pedicle screws - intraoperative CT

• Literatur

• 1 Castro WH, Halm H, Jerosch J. et al. Accuracy of pedicle screw placement in lumbar vertebrae. Spine 1996; 21: 1320-1324
• 2 Laine T, Lund T, Yilkoski M. et al. Accuracy of pedicle screw insertion with and without computer assistance: a randomized controlled clinical study in 100 consecutive patients. Eur Spine J 2000; 9: 235-40
• 3 Amiot LP, Labelle H, De Guise JA. et al. Computer assisted pedicle screw installation. Our first 3 cases. Ann Chir 1996; 50: 626-630
• 4 Nolte LP, Zamorano L, Visarius H. et al. Clinical evaluation of a system for for precision enhancement in spine surgery. Clin Biomech 1995; 10: 293-303
• 5 Omay SB, Barnett GH. Surgical navigation for meningioma surgery. J Neurooncol 2010; 99: 357-364
• 6 Willems PW, Sprenkel JW van der, Tulleken CA. et al. Neuronavigation and surgery of intracerebral tumours. J Neurol 2006; 253: 1123-1136
• 7 Gebhard F, Kinzl L, Arand M. Navigation – Erfahrung zu Kosten und Nutzen. Trauma Berufskrankh 2004; 6: S202-S206
• 8 Arand M, Teller S, Gebhard F. et al. (2008) Klinische Präzision der C-Arm-Navigation an der Brust und Lendenwirbelsäule. Z Orthop Unfall 2008; 146: 458-462
• 9 Kotani T. et al. Accuracy of pedicle screw placement in scoliosis surgery: A comparison between conventional computed tomographybased and O-arm-based navigation techniques. Asian Spine J 2014; 8, 3: 331-338
• 10 Jarvers JS, Katscher S, Franck A. et al. 3D-Based navigation in posterior stabilisations of the cervical and thoracic spine: problems and benefits. Eur J Trauma Emerg Surg 2011; 37: 109-119
• 11 Richter PH, Gebhard F, Kraus M. Bedeutung der intraoperativen Navigation in der Wirbelsäulenchirurgie. Chirurg 2014; 85: 929-942
• 12 K. Abdullah F, Bishop D, Lubelski EC. et al. Radiation exposure to the spine surgeon in lumbar and thoracolumbar fusions with the use of an intraoperative computed tomographic 3-Dimensional imaging system. Spine 2012; 37, 17: E1074-E1078
• 13 Gebhard FT, Kraus MD, Schneider E. et al. Does computer-assisted spine surgery reduce intraoperative radiation doses?. Spine 2006; 31: 2024-2028
• 14 Villard J, Ryang YM, Demetriades AK. et al. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976) 2014; 1; 39: 1004-1009
• 15 Hüfner T, Stübig T, Gösling T. et al. Kosten- und Nutzenanalyse der intraoperativen 3D-Bildgebung. Unfallchirurg 2007; 110: 14-12
• 16 Gonschorek O, Jarvers JS. Intraoperative Bildgebung und Navigation. In: Buhren V, Josten C. (Hrsg) Chirurgie der verletzten Wirbelsäule. Berlin, Heidelberg: Springer; 2013: 135-1179
• 17 Larson AN, Santos ER, Polly Jr DW . et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine 2012; 37: E188-E194
• 18 Shimokawa N, Takami T. Surgical safety of cervical pedicle screw placement with computer navigation system. Neurosurg Rev. Berlin Heidelberg: Springer; 2016: 1-8
• 19 Hojo Y, Ito M, Suda K. et al. A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 screws. Eur Spine J 2014; 23: 2166-2174
• 20 Uehara M, Takahashi J, Ikegami S. et al. Screw perforation rates in 359 consecutive patients receiving computer-guided pedicle screw insertion along the cervical to lumbar spine. Eur Spine J 2016; [Epub ahead of print]
• 21 Hecht N, Yassin H, Czabanka M. et al. Intraoperative Computed Tomography Versus 3D C-Arm Imaging for Navigated Spinal Instrumentation. Spine 2017; [Epub ahead of print]
• 22 Costa F, Ortolina A, Attuati L. et al. Management of C1–2 traumatic fractures using an intraoperative 3D imaging-based navigation system. J Neurosurg Spine 2015; 22: 128-133
• 23 Zou D, Zhang K, Ren Y. et al. Three-dimensional image navigation system-assisted anterior cervical screw fixation for treatment of acute odontoid fracture. Int J Clin Exp Med 2014; 7: 4332-4336
• 24 Gottschalk MB, Yoon ST, Park DK. et al. Surgical training using three-dimensional simulation in placement of cervical lateral mass screws: a blinded randomized control trial. Spine J 2015; 15: 168-175
• 25 Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine 1990; 15: 11-14
• 26 Helm PA, Teichman R, Hartmann SL. et al. Spinal Navigation and Imaging: History, Trends, and Future (2015). IEEE Trans Med Imaging 2015; 34: 1738-1746
• 27 Van de Kelft E, Costa FVan de Planken D. et al. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and stealthstation navigation. Spine 2012; 37, 25: E1580-E1587
• 28 Costa F, Porazzi E, Restelli U. et al. Economic study: A cost-effectiveness analysis of an intraoperative compared with a preoperative image-guided system in lumbar pedicle screw fixation in patients with degenerative spondylolisthesis. Spine J 2014; 14, 8: 1790-1796
• 29 Houten JK, Nasser R, Baxi N. Clinical assessment of percutaneous lumbar pedicle screw placement using the O-arm multidimensional surgical imaging system. Neurosurgery 2012; 70, 4: 990-995
• 30 Kraus MD, Krischak G, Keppler P. et al. Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion?. Clin Orthop Relat Res 2010; 468: 2419-2429
• 31 Mason A, Paulsen R, Babuska JM. et al. The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine 2014; 20: 196-203
• 32 Ryang Y, Villard J, Obermüller T. et al. Learning curve of 3D fluoroscopyimage-guided pedicle screw placement in the thoracolumbar spine. Spine J 2015; 15, 3: 467-476
• 33 Shin MH, Hur JW, Ryu KS. et al. Prospective comparison study between the fluoroscopy guided and navigation coupled with O-arm^® guided pedicle screw placement in the thoracic and lumbosacral spines. J Spinal Disord Tech 2013; 28: E347-E351
• 34 Blattert TR, Jarvers JS, Schmidt C. et al. Anterior column reconstruction in thoracolumbar injuries utilizing a computer-assisted navigation system. Eur J Trauma Emerg Surg 2011; 37: 127-133
• 35 Gonschorek O, Hauck S, Spiegl U. et al. O-arm^® -based spinal navigation and intraoperative 3D-imaging: first experiences. Eur J Trauma Emerg Surg 2011; 37: 99-108