Comput. Aided Surg. - Comparison of multilevel oblique corpectomy with and without image guided navigation for multi-segmental cervical spondylotic myelopathy.


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JECTIVE: Multilevel Oblique Corpectomy (MOC) is an emerging technique for surgical treatment of multi-segmental cervical spondylotic myelopathy (CSM) featuring extensive ossification of the posterior longitudinal ligament (OPLL). However, the use of an oblique drilling plane is unfamiliar to most surgeons and there is no anatomical landmark present on the posterior portion of the vertebral body. To overcome these difficulties, the authors used intraoperative C-arm-based image guided navigation (IGN), and this study was conducted to evaluate the efficacy of IGN in MOC.METHODS: Following the introduction of IGN for MOC, 24 patients underwent MOC procedures at our institution. Two patients who had undergone previous cervical operations were excluded from the present study. Of the remaining 22 patients, 11 underwent MOC with IGN, and 11 underwent MOC without IGN support. The completeness of MOC (CMOC) is measured as the sum of the bilateral remaining posterior body minus the remaining approach-side anterior body in millimeters at the most compressive level. For each patient, the preoperative Japanese Orthopaedic Association Score (JOAS) and postoperative 5th day JOAS were collected as well as several other perioperative parameters.RESULTS: The mean CMOC was 0.89mm for the IGN group and 5.9mm for the control group. The mean change in JOAS was 5.58 for the IGN group and 3.34 for the control group at 1-year follow-up. In the control group, two patients underwent re-exploration due to remaining OPLL. Despite the intraoperative IGN set-up time, the mean operation time for the IGN group was shorter than that for the control group (248min versus 259min). Mean treated levels were 3.55 for the IGN group and 3.36 for the control group.CONCLUSION: Through the use of image guided navigation, it was possible to accomplish faster and more complete MOC.

Resumo Limpo

jectiv multilevel obliqu corpectomi moc emerg techniqu surgic treatment multisegment cervic spondylot myelopathi csm featur extens ossif posterior longitudin ligament opll howev use obliqu drill plane unfamiliar surgeon anatom landmark present posterior portion vertebr bodi overcom difficulti author use intraop carmbas imag guid navig ign studi conduct evalu efficaci ign mocmethod follow introduct ign moc patient underw moc procedur institut two patient undergon previous cervic oper exclud present studi remain patient underw moc ign underw moc without ign support complet moc cmoc measur sum bilater remain posterior bodi minus remain approachsid anterior bodi millimet compress level patient preoper japanes orthopaed associ score joa postop th day joa collect well sever periop parametersresult mean cmoc mm ign group mm control group mean chang joa ign group control group year followup control group two patient underw reexplor due remain opll despit intraop ign setup time mean oper time ign group shorter control group min versus min mean treat level ign group control groupconclus use imag guid navig possibl accomplish faster complet moc

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