A C-Arm-Free Minimally Invasive Technique for Spinal Surgery: Cervical and Thoracic Spine

Abstract

Background and Objectives: C-arm-free MIS techniques can offer significantly reduced rates of postoperative complications such as inadequate decompression, blood loss, and instrumentation misplacement. Another advantageous long-term aspect is the notably diminished exposure to radiation, which is known to cause malignant changes. This study emphasizes that, in some cases of spinal conditions that require a procedural intervention, C-arm-free MIS techniques hold stronger indications than open surgeries guided by image intensifiers. Materials and Methods: This study includes a retrospective analysis and review of various cervical and thoracic spinal procedures, performed in our hospital, applying C-arm-free techniques. The course of this study explains the basic steps of the procedures and demonstrates postoperative and intraoperative results. For anterior cervical surgery, we performed OPLL resection, while for posterior cervical surgery, we performed posterior fossa decompression for Chiari malformation, minimally invasive cervical pedicle screw fixation (MICEPS), and modified Goel technique with C1 lateral mass screw for atlantoaxial subluxation. Regarding the thoracic spine, we performed anterior correction for Lenke type 5 scoliosis and transdiscal screw fixation for diffuse idiopathic skeletal hyperostosis fractures. Results: C-arm-free techniques are safe procedures that provide precise and high-quality postoperative results by offering sufficient spine alignment and adequate decompression depending on the case. Navigation can offer significant assistance in the absence of normal anatomical landmarks, yet the surgeon should always appraise the quality of the information received from the software. Conclusions: Navigated C-arm-free techniques are safe and precise procedures implemented in the treatment of surgically demanding conditions. They can significantly increase accuracy while decreasing operative time. They represent the advancement in the field of spine surgery and are hailed as the future of the same.

Keywords: C-arm free; adult spinal deformity; lateral access spine surgery; minimally invasive spine surgery; oblique lumbar interbody fusion.

Figure 1

Case 1: 82-year-old male; cervical OPLL, anterior cervical corpectomy and fusion. (A) Preoperative cervical lateral radiogram. (B) Preoperative CT sagittal reconstruction image. (C) Intraoperative sagittal navigation image. (D) Intraoperative axial navigation image. (E) Intraoperative image. (F) Postoperative cervical lateral radiogram.

Figure 2

Case 2: 14-year-old female; Chiari malformation, foramen magnum decompression. (A) Preoperative occipitocervical CT sagittal reconstruction. (B) Intraoperative navigation image. (C) Intraoperative image. (D) Postoperative occipitocervical CT sagittal reconstruction.

Figure 3

Case 3: 5-year-old male; Down syndrome, anterior atlantoaxial subluxation, modified Goel technique. (A) Preoperative lateral cervical radiogram. (B,C) Intraoperative navigation image of C2 pedicle screw insertion. (D,E) Intraoperative navigation image of C1 lateral mass screw insertion. (F) Intraoperative image. (G) Postoperative lateral cervical radiogram.

Figure 4

Case 4: 68-year-old male; anterior atlantoaxial subluxation, modified Goel fixation. (A) Preoperative cervical lateral radiogram. (B) Preoperative midsagittal T2 weighted MR imaging. (C) Intraoperative navigated high-speed burr. (D) Intraoperative lateral mass screwing. (E) Various C1 lateral mass entry points in lateral. (F) Insertion point of mid-point technique (red circle). (G) Postoperative cervical lateral radiogram.

Figure 5

Case 5: 62-year-old female; Brest cancer, C4 metastasis, C2–C6 posterior fusion. (A) Preoperative cervical lateral radiogram. (B) Intraoperative image. (C) Intraoperative sagittal navigation image. (D) Intraoperative axial navigation image. (E) Postoperative cervical lateral radiogram.

Figure 6

Case 6: 15-year-old female; adolescent idiopathic scoliosis LT11-L3enke Type 5C, T12-L3 anterior fusion. Preoperative 46 degrees of Cobb angle (T12-L3) became 1 degree. (A) Preoperative posteroanterior spine radiogram. (B) Preoperative lateral spine radiogram. (C) Intraoperative image. (D) Intraoperative axial navigation image. (E) Intraoperative coronal navigation image, (F) Postoperative posteroanterior spine radiogram. (G) Postoperative lateral spine radiogram.

Figure 7

Case 8: 85-year-old male; T8 fracture of diffuse idiopathic skeletal hyperostosis (DISH) patient. (A) Preoperative sagittal reconstruction CT. (B) Preoperative sagittal T1 weighted MR imaging. (C) Intraoperative image. (D) Intraoperative sagittal navigation image. (E) Intraoperative axial navigation image. (F) Intraoperative 3D navigation image. (G) Postoperative anteroposterior radiogram. (H) Postoperative lateral radiogram.