The Application of O-arm and Navigation System in Precise Localization of Spinal Cord lesions: a Case Series study
Introduction
In recent years, more and more spinal surgeries assisted by O-arm and navigation system have been reported, and the clinical value of this technology has been continuously recognized [[1], [2], [3], [4], [5]]. However, most of them were studies on the accuracy of spinal pedicle screw placement, and few studies focused on the intra-operative precise localization of spinal cord lesions.The anatomical localization between spine cord lesions and spine is closely related. X-rays are often used to locate the spinal segment during surgeries, especially for small spinal cord lesions. According to the clinical experience of operators, surgical exploration is performed,which may not only cause damage to the spinal cord function, but also the biomechanical stability of the spine. In some cases, the patients need to accept an avoidable spinal interbody fusion.
With the application of multimodal image fusion technology in intracranial lesions, some researchers attempted to perform intraoperative localization of spinal cord lesions [[6], [7], [8]]. In 2018, our research team reported a novel technique of images fusion between preoperative MRI and intraoperative cross-sectional images, and successfully located 5 small intramedullary spinal cord lesions [6]. However, the number of cases is small and the cases of extramedullary lesions were not included.Based on previous datas, this study increased the number of cases, including extramedullary and intervertebral foramen lesions, which are reported as follows.
Section snippets
Methods
From Augst 2015 to September 2019, 22 patients with spinal cord lesions who had O-arm and navigation system assisted surgeries in Beijing Tsinghua Changgung hospital were arranged in the group. There were 10 males and 12 females, which include 10 cervical, 7 thoracic, and 5 lumbar lesions. The main symptoms of patients included weakness (10 cases), dysaesthesia (6 cases), physical pain (5 cases), paraplegia and incontinence (1 case). Preoperative McCormick score was class IV in 1 case, class
Results
22 cases of spinal lesions were totally resected under microscopy, assisted by o-arm and navigation systems. Postoperative pathology confirmed 1 gangliocytoma, 1 meningioma, 1 capillary hemangioma, 1 neurofibroma, 1 arteriovenous malformation, 1 hemangioblastoma, 2 nerve root cyst, 5 cavernous hemangioma, 3 ependymoma, and 6 schwannoma. 3 months later after surgeries, the McCormick score was class IV 1 case, class II 4 case, class I 17 cases.
The clinical symptoms of all patients have been
Discussion
A surgical treatment is preferred recommendation for spinal cord lesions in most cases [9,10], and the surgery requires localization of spinal segments, which is different from craniotomy. Mody et al reported that the probability of performing an operation on wrong sites of spine is 0.032% ∼ 15% [[11], [12], [13]]. In recent years, the O-arm and navigation systems were widely used in spinal surgeries [[14], [15], [16], [17]]. Agrawal et al [14] reported 57 patients in whom 210 screws were
Funding
Beijing Tsinghua Changgung Hospital Found (Grant NO. 12015C1044).
CRediT authorship contribution statement
Peihai Zhang: Conceptualization, Methodology, Software, Writing - original draft. Huiting Liu: Conceptualization, Methodology, Software, Writing - original draft. Zhenxing Sun: Data curation, Formal analysis, Investigation. James Wang: Data curation, Formal analysis, Investigation. Guihuai Wang: Writing - review & editing, Supervision.
Acknowledgement
Thank numerous individuals participated in this study.
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These authors contributed equally to this work.