Intraoperative CT navigation in spinal and pelvic surgery: initial experience

Authors: V. Džupa 1,2;  M. Krbec 2;  R. Kadeřábek 3;  R. Rusnák 1,4;  P. Douša 2;  J. Skála-Rosenbaum 2;  F. Fridrich 2;  V. Báča 1,5;  R. Grill 1,6
Authors‘ workplace: Centrum pro integrované studium pánve 3. LF UK, Praha, vedoucí lékař: Doc. MUDr. R. Grill, PhD. 1;  Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha, přednosta: Prof. MUDr. M. Krbec, CSc. 2;  Radiodiagnostická klinika 3. LF UK a FNKV, Praha, přednosta: Doc. MUDr. V. Janík, CSc. 3;  Neurochirurgická klinika, spondylochirurgické oddelenie Ústrednej vojenskej nemocnice SNP FN Ružomberok, primár: MUDr. R. Rusnák, PhD. 4;  Ústav anatomie 3. LF UK, Praha, přednosta: Doc. MUDr. P. Zach, CSc. 5;  Urologická klinika 3. LF UK a FNKV, Praha, přednosta: Doc. MUDr. R. Grill, PhD. 6
Published in: Rozhl. Chir., 2013, roč. 92, č. 7, s. 379-384.
Category: Original articles

Práce vznikla za podpory strukturálních fondů Evropské unie, Operačního programu Praha Konkurenceschopnost CZ216/3100/24018 (INO/02/01/0017/2010): Podpora baze základního výzkumu Centra pro integrované studium pánve.


The authors describe their first experience with virtually navigated pelvic and spine screws based on perioperative CT navigation.

Material and methods:
From 22 October 2012 (launching the device) to 9 January 2013, a total of 15 CT-navigated pelvic and spine operations were performed in 14 patients. Nerve root compression, scoliosis, vertebral fracture and spondylodiscitis were the indications for spine procedures; B-type and C-type fractures according to the AO classification were the indications in pelvic surgical procedures. The preparation and the course of the procedures were in accordance with current standards and recommendations in all the cases. Perioperative navigation and subsequent examination of the screw trajectory were performed via O-arm imaging system (Medtronic Navigation, Louisville, Colorado) instead of the standard C-arm fluoroscopy.

A total of 73 screws were inserted (60 transpedicular screws into cervical, thoracic and lumbar vertebrae, 9 iliosacral screws into the first sacral vertebra and 4 pubic screws). Only one of the pubic screws (1.4% of all screws) was found malpositioned at the subsequent perioperative examination and was extracted immediately and replaced. Further complications were not observed and none of the procedures had to be converted into a standard fluoroscopy guided operation.

A short but intensive experience with perioperative CT navigation allows us to state: 1. CT navigation shortens the operating time and minimalizes the risk of screw malposition in multiple screw spine procedures; 2. CT navigation improves the introduction of iliosacral and pubic screws in pelvic fixations; 3. there is virtually no radiation load to the staff using the CT navigation; 4. mastering this technique will allow a wider use of miniinvasive screw insertion in the pelvis and other regions where minimal dislocation will enable miniinvasive internal fixation.

Key words:
CT navigation – transpedicular screw – iliosacral screw – pubic screw


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Surgery Orthopaedics Trauma surgery
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