Technique, Time Demand, Radiation Exposure, and Outcomes of Skin-anchored Intraoperative 3D Navigation in Minimally Invasive Posterior Cervical Laminoforaminotomy

Abstract

Objective: The objective of this study was to describe our technique and evaluate the time demand, radiation exposure, and outcomes of minimally invasive posterior cervical laminoforaminotomy (MI-PCLF) using skin-anchored intraoperative navigation (ION).Background: Although bone-anchored trackers are most commonly used for ION, a novel technique utilizing noninvasive skin-anchored trackers has recently been described for lumbar surgery and has shown favorable results. There are currently no reports on the use of this technology for cervical surgery.Methods: Time demand, radiation exposure, and perioperative outcomes of MI-PCLF using skin-anchored ION were evaluated.Results: Twenty-one patients with 36 operative levels were included. Time for ION setup and operative time were a median of 34 and 62 minutes, respectively. Median radiation to the patient was 2.5 mGy from 10 seconds of fluoroscopy time. Radiation exposure to operating room personnel was negligible because they are behind a protective lead shield during ION image acquisition. There were no intraoperative complications or wrong-level surgeries. One patient required a repeat ION spin, and in 2 patients, ION was abandoned and standard fluoroscopy was used.Conclusions: Skin-anchored ION for MI-PCLF is feasible, safe, and accurate. It results in short operative times, minimal complications, low radiation to the patient, and negligible radiation to operating room personnel.

Surface Navigation and the Influence of Navigation on MIS Surgery

“…Surface-based ION is a relatively novel concept in MIS and few studies to-date have been published describing its accuracy, time-demand, radiation exposure, and outcomes. [11][12][13][14] Surface-based navigation is useful for the full spectrum of MIS procedures, ranging from tubular decompressions to multi-level fusions. Bone-anchored systems are rarely used in noninstrumented procedures because the invasiveness required for setup is disproportionate to the inherent invasiveness of the surgeries themselves, however this is not the case with surface-based ION.…”

“…Global Spine Journal 12(2S) 12 The median time for ION setup was 34 minutes. Fluoroscopy time and radiation dose, respectively, were a median of 10 seconds and 2.5 mGy exposure to the patient; exposure to operating room personnel was negligible as they were protected by a lead shield during image acquisition.…”

“…A similar study by Vaishnav et al, evaluated the use of surface-based ION in 21 patients undergoing minimally invasive posterior cervical laminoforaminotomy. 12 The median time for ION setup was 34 minutes. Fluoroscopy time and radiation dose, respectively, were a median of 10 seconds and 2.5 mGy exposure to the patient; exposure to operating room personnel was negligible as they were protected by a lead shield during image acquisition.…”

“…Surface-based ION is a relatively novel concept in MIS and few studies to-date have been published describing its accuracy, time-demand, radiation exposure, and outcomes. 11 - 14 …”

“…Fluoroscopy time and radiation dose, respectively, were a median of 10 seconds and 2.5 mGy exposure to the patient; exposure to operating room personnel was negligible as they were protected by a lead shield during image acquisition. 12 There were no wrong-level surgeries; instrumentation accuracy was not reported as no patients underwent subaxial lateral mass or pedicle screw placement. 12 …”