The Application of O-arm and Navigation System in Precise Localization of Spinal Cord lesions: a Case Series study

https://doi.org/10.1016/j.clineuro.2020.105922Get rights and content

Highlights

  • To study on the novel method of precisely intraoperative localization of spinal cord lesions.

  • By using the O-arm and navigation system, we accomplished the image fusion of intraoperative CT images and preoperative MRI images. The fused images were used to localize the spinal cord lesions.

  • The results confirmed its clinical feasibility and value.

Abstract

Objective

To study on the clinical efficacy of precise localization of O-arm and navigation system in spinal cord lesions.

Methods

From Augst 2015 to September 2019, 22 patients with spinal cord lesions were arranged in the group.The intraoperative cross-sectional images were acquired by O-arm image system, which were transferred to the Stealth navigation system, and fused with pre-opreative MRI images. The image fusion was completed by the Medtronic Synergy Cranial software. The fused images were used to locate spinal cord lesions, assisted by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the lesion in MRI and its real position.

Results

The image fusion were completed in all patients, and we successfully completed the image-guided surgeries of the spinal cord lesions. The time of image processing was between 7 min and 19 min, and the mean value was 15.1 ± 2.2 min. The navigation error was between 0.9 mm and 5.3 mm, the mean value was 1.6 ± 0.9 mm.

Conclusion

The application of precise localization of O-arm and navigation system in spinal cord lesions is clinically reliable and feasible.

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.

References (19)

There are more references available in the full text version of this article.

Cited by (0)

1

These authors contributed equally to this work.

View full text