Navigation-assisted surgery for tumors of the spine

Abstract

Purpose: Computer-assisted navigation systems are largely used for pedicle screws positioning in degenerative and traumatic spine surgery. In oncologic spine surgery its use is still developing and could be extended for tumor identification and excision. Aim of this paper is to present our experience.

Methods: Seven selected patients (5 females, 2 males), mean age 44 years (min 17-max 62) affected by primary benign or malignant tumors of the spine or spine metastases were surgically treated with the use of computer-assisted navigation system from March to October 2011.

Results: At 18 months mean F.U. (min 15-max 23), no LR were observed. Revision surgery was necessary only in one case for C1 pedicle screw malpositioning.

Conclusions: Navigation system can improve surgical accuracy in screws placement and tumor localization and excision. Learning curve and technical aspects must be considered to avoid potential serious mistakes.

Fig. 1

C.C. 52 years, L2 uterus metastases (a, b). Using navigator system, the patient was subjected to minimally invasive L1–L3 instrumentation (c). On the site of the tumor a working camera was positioned (d) whereby, by a navigated high-speed burr, the excision of the tumor was performed through the lamina and the pedicle (e). Post-op CT scan shows the good position of the minimally invasive screws and the amount of the decompression (f, g, h). At 6 months from the surgery, CT scan shows a good local control of the disease (i)

Fig. 2

M.A. 61 years, L5 melanoma metastases (a, b). A histological slide obtained by a CT-trocar biopsy confirmed the diagnosis (tissue positive to MART 1) (c). After an open laminectomy, using navigator system, four needles were positioned around the lesion and electroporation was performed (d, e, f). A good local control of the disease was confirmed by a CT-trocar biopsy performed 6 months after surgery (necrotic tissue) (g, h)

Fig. 3

R.R. 62 years, C2 pathological fracture due to plasmocytoma. Post-operative CT scan shows C1 screws malpositioning