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[Posterior spinal instrumentation image guided and assisted by neuronavigation. Experience in 120 cases]

INTRODUCTION: The authors present the results of a series of 121 cases of posterior vertebral fixation carried out from Sept 2008 to Sept 2010 using Flouro 2D-TC assisted Vector Vision o Kolibri navigator. ( Brain LAB, Feldkirchen, Germany). MATERIAL: The sample included 68 males and 53 females. Age range was 24-75 with an average of 50.35., all with indication for instrumentation by different pathologies. METHOD: Patients presenting vertebral lesions of varying ethiology and lesion level with vertebral posterior fixation indication were included in the study. All underwent a CT before surgery, according to navigation protocol, and the images obtained were merged in the navigator with those obtained in the operating room with a Flouro 2D, which allowed a high quality 3D reconstruction to be performed and thus the capacity to navigate in a real-virtual manner. To evaluate the results of the implant a post-op CT was performed and the position of the implant was defined according to the Heary scale. The calabration time of the material was also evaluated, number of shots with the Flouro-2D, and for clinical evaluation VAS scales were employed, Oswestry and JOA (L), as well as the degree of satisfaction and acceptance of the procedure. RESULTS: A total of 580 screws were implanted, distributed in 62 cervicals of which 24 were in C1-C2, 38 dorsals, 370 lumbar and 110 sacral. Open surgery was performed in 42 cases, MIS in 28 and percutaneous in 51. The presision of the implant was 98.45% with a global deviation of 1.55%, that according to the Heary scale was distributed in grade ll: 2 (1 cervical, 1 lumbar) grade lll: 4 (1 cervical, 2 dorsal, 1 lumbar), grade IV: 3 (1 cervical, 2 lumbar). General average time of calibration per procedure was 2 min. 49 seconds and the mean flouroscopic exposure was one shot at cervical and dorsal and two shots at lumbar level. The clinical evaluation at one month of 121 patients was 8.6/3.0 in the VAS, 68.0% / 23.0% in Oswestry and 6.4/13.1 in JOA (L), with those parameters remaining stable at 3 months in 100 and at 6 months in 87 patients respectively, and the degree of satisfaction between being completely and very satisfied with the procedure was 94.9%, and those who would submit to another treatment was more than 94%. CONCLUSION: Navigation with Flouro-2D-CT is a high precision technique that reduces complications of varying severity according to the level operated well as number of reinterventions, radiation exposure and surgical time

Keywords : Adult,Aged,Bone Screws,Brain,complications,Female,Fluoroscopy,Fracture Fixation,Internal,Germany,Humans,instrumentation,Male,methods,Middle Aged,Neuronavigation,Osteoarthritis,pathology,Patient Satisfaction,Patients,Preoperative Care,Radiography,Interventional,Retrospective Studies,Spinal Diseases,Spinal Fractures,Spinal Neoplasms,Spine,Spondylitis,surgery,Surgery,Computer-Assisted,Time,Tomography,X-Ray Computed,Young Adult,, Spinal,Instrumentation,Image,Guided, physio ice packs

Date of Publication : 2011 Jun

Authors : Florensa R;Munoz J;Cardiel I;Bescos A;Tardaguila M;Plans G;Dominguez CJ;Colet S;

Organisation : Servicio de Neurocirugia Hospital Germans Trias i Pujol. Barcelona. rflorensa.germanstrias@gencat.cat

Journal of Publication : Neurocirugia (Astur )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21743943

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