Use of image-guided bone scalpel for resection of spine tumors: technical note

Abstract

In the literature, the use of navigation for spine tumor surgery has largely centered on implant placement. We describe the cases of two patients with spinal tumors on whom we utilized our resection technique of registering an ultrasonic bone scalpel (UBS) to a navigation system. In both cases, we achieved a satisfactory tumor resection with negative margins and excellent neurologic outcomes. We feel that using the navigation-registered UBS is a valuable tool to increase the operator's ability to achieve desired resections while minimizing the neurologic deficits and operative morbidity associated with these challenging surgical cases.

Keywords: Image-guided navigation; primary spine tumor; sacral chordoma; ultrasonic bone scalpel (UBS).

Figure 1

Pre-operative sagittal and axial T1-weighted MRI images with contrast (A,B), pre-operative sagittal and axial non-contrast CT images (C,D), ultrasonic bone scalpel configured for image-guided navigation (E), image of osteotomy cut on navigation platform (F), intraoperative use of the ultrasonic bone scalpel using image-guided navigation (G), intraoperative image of tumor (H), marginally excised specimen (I), post-operative sagittal and axial T1-weighted MRI images with contrast (J,K).

Figure 2

Pre-operative sagittal and axial T1-weighted MRI images with contrast (A,B), intraoperative fluoroscopic image illustrating operative set-up (C), post-operative parasagittal non-contrast CT image (D), post-operative sagittal non-contrast CT image (E).