Ohnsorge J A K, Siebert C H, Schkommodau E, Mahnken A H, Prescher A, Weisskopf M
Orthopädische Universitätsklinik, UKA, RWTH Aachen.
Z Orthop Ihre Grenzgeb. 2005 Mar-Apr;143(2):195-203. doi: 10.1055/s-2005-836514.
The transpedicular placement of a hollow needle into vertebral bodies for kyphoplasty requires utmost accuracy and thereby permanent multiplanar X-ray control. Facing the increasing number of vertebral compression fractures, the aim of this work was the implementation of computer-assistance to optimise the issue. Prior to clinical implementation, experimental trials were undertaken to analyse the quality-improving options of the technique.
The virtual image of the planning and the puncture were correlated with the postoperative X-ray image of the needle. The real canal in the bone was then correlated with the preoperative planning in a CT-based 3D model and differences were calculated. As a measure of accuracy the deviation of the needle from the ideal intruding vector and the distance between its top and the centre of a predefined target were scrutinised and related to the indications of the navigation system. Operating time, radiation exposure and general applicability were additionally assessed. All data were compared with those of a conventional control group.
Planning and navigation could be executed with high accuracy. With an exactly transpedicular approach, neural structures were safely circumnavigated without once missing the target. In the control group the distance fault was up to 9 mm. The navigated drilling differed from the ideal trajectory by 1 degrees to max. 4 degrees. Conventional C-arm control led to a divergence of 4 degrees to 8 degrees . Radiation exposure could be reduced through computer assistance by 76 % to a fourth of the conventionally resulting amount and the pure operating time thereby decreased by 40 %. The inconvenient course of repeated positioning of the C-arm was overcome.
In challenging cases of deteriorated anatomy and difficult radiomorphologic orientation, especially of the lower thoracic spine, the CAOS-procedure succeeds in finding the optimal pedicular approach to the vertebral body, helps to avoid collateral damage and minimises the overall risk of the procedure. High accuracy and reduced radiation exposure justify the clinical use of fluoroscopic navigation for transpedicular instrumentation.
