Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Spine (Phila Pa 1976). 2009 Oct 15;34(22):E800-5. doi: 10.1097/BRS.0b013e3181ab3ce8.
Technical note.
To introduce the application of navigation system with software for brain surgery to the upper cervical spine of patients who have previously had occipitocervical (O-C) fusion.
The anterior approach to the spine using a navigation system with software for spine surgery is difficult because the registration tends to be inaccurate. However, after O-C fusion, the upper cervical spine is considered part of the skull, and a navigation system with software for brain surgery in which the registration is performed using the head with several markers attached to it can be applied.
Three patients with previous O-C fusion-2 with upper cervical chordoma and 1 with a disc herniation at C2/3-were treated using this technique.
In the first case, with a huge retropharyngeal C1 chordoma, this technique was very helpful in blindly dissecting the nonvisible parts of the tumor. In the second case, with a C2 chordoma, the vertebral arteries were successfully exposed under the guidance of the navigation system at both primary and revision surgery. In the third case, with disc herniation at C2/3, the herniated disc was removed successfully with the totally fused spine. In this application, computed tomography images can be merged freely with magnetic resonance images, which is helpful to clarify the soft tissues such as tumor, disc herniation, or the dural tube.
This technique greatly supports surgeons inexperienced in the anterior approach to the upper cervical spine or surgeons at revision surgery who may be lost in and daunted by an unfamiliar operation field surrounded by important structures. Although an anterior approach to the upper cervical spine in the patient with O-C fusion may rarely be required, this application should be considered.
技术说明。
介绍将用于脑部手术的导航系统软件应用于先前行枕颈（Occipitocervical，O-C）融合的上颈椎患者。
使用用于脊柱手术的导航系统进行脊柱前路手术较为困难，因为注册往往不准确。然而，在 O-C 融合后，上颈椎被视为颅骨的一部分，并且可以应用注册时使用附有几个标记的头部的用于脑部手术的导航系统软件。
使用该技术治疗了 3 例先前有 O-C 融合的患者，其中 2 例为上颈椎脊索瘤，1 例为 C2/3 椎间盘突出症。
在首例巨大的咽后 C1 脊索瘤病例中，该技术在盲目解剖肉眼不可见的肿瘤部分时非常有帮助。在第二个病例中，在原发性和翻修手术中，导航系统成功地暴露了椎动脉。在第三个病例中，C2/3 椎间盘突出症，完全融合的脊柱成功地切除了突出的椎间盘。在这种应用中，计算机断层扫描图像可以与磁共振成像自由融合，有助于明确肿瘤、椎间盘突出或硬脑膜管等软组织。
该技术极大地支持了在上颈椎前路手术方面缺乏经验的外科医生或可能对周围重要结构的陌生手术区域感到迷失和畏惧的翻修手术外科医生。虽然患者可能很少需要 O-C 融合的上颈椎前路手术，但应考虑这种应用。
