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Relevanz der spinalen Navigation in der rekonstruktiven Halswirbelsäulenchirurgie

Relevance of spinal navigation in reconstructive surgery of the cervical spine

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Zusammenfassung

Hintergrund

Die spinale Navigation hat im Verlauf der letzten zwei Jahrzehnte erhebliche Fortschritte gemacht. Nach ersten Erfahrungen mit Pedikelschrauben in der Lendenwirbelsäule (LWS) und Brustwirbelsäule (BWS) haben die technologischen Verbesserungen zu einer vermehrten Anwendung im Bereich der Halswirbelsäule geführt. Operative Techniken, wie zervikale Pedikelschrauben, Massa-lateralis-Schrauben im Halswirbelkörper (HWK) 1 und transartikuläre C1/C2-Schrauben haben sich mithilfe der Navigation als Standardverfahren etabliert. Die verschiedenen Techniken der spinalen Navigation unterscheiden sich anhand des bildgebenden Datensatzes.

Technik

An der Halswirbelsäule (HWS) ist die präoperative Computertomographie (CT) mit der Notwendigkeit des intraoperativen Matchings aufgrund der hohen Bildqualität immer noch der klinische Standard. Die BV-basierte 3‑D-Navigation hat in den letzten Jahren eine breite Anwendung an der LWS gefunden, ist aber an der HWS bei komplexen anatomischen Verhältnissen sowie in den Übergangsregionen aufgrund der schlechteren Bildqualität nur eingeschränkt einsetzbar. Die zukünftige Verfügbarkeit der intraoperativen CT (iCT) kombiniert die Vorteile der hohen Bildqualität mit den Vorteilen der intraoperativen Bildakquise. Dies wird zu einer weiteren Verbreitung der spinalen Navigation an der HWS führen und zukünftig auch minimalinvasive Techniken mit hoher Präzision ermöglichen.

Anwendung

Die erfolgreiche Anwendung der spinalen Navigation basiert auf der Kenntnis der technischen Grundlagen und einen routinemäßigen Einsatz im klinischen Alltag. Nur mit ausreichender Erfahrung des Operationsteams lassen sich die Arbeitsabläufe optimieren, was dann neben der erhöhten Sicherheit auch zu einer Reduktion der Strahlenbelastung und Verkürzung der Operationszeiten führt.

Abstract

Background

Spinal navigation has made significant advances in the last two decades. After initial experiences with pedicle screws in the thoracic and lumbar spine, technological improvements have resulted in their increased application in the cervical spine. Instrumentation techniques like cervical pedicle screws, lateral mass screws in C1 and transarticular screws C1/C2 have become standard due to the application of image guidance.

Technique

Different navigation techniques can be distinguished based on the type of imaging. In the cervical spine, the preoperative computer tomography (CT) scan that requires intraoperative matching is still the standard of care due to the high image quality. 3D fluoroscopy navigation techniques are currently widely used in the lumbar spine, but the reduced image quality obviates the application in the more sophisticated cervical anatomy or the cervicothoracic region. The future availability of intraoperative CT scans (iCT) combines the advantages of high image quality with those of intraoperative image acquisition. This will lead to a wider use of image guidance in the cervical spine and will enable the surgeon to apply minimally invasive techniques with higher accuracy.

Application

The successful application of spinal navigation is based on the technical knowledge of navigation systems and its exercise in daily routine. Only the sufficient experience of the clinical staff makes it possible to standardize operational procedures to increase patient safety, reduce radiation dose and shorten operation time.

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Abbreviations

BV:

Bildverstärker

BWS:

Brustwirbelsäule

CCÜ:

Kraniozervikaler Übergang

CT:

Computertomographie

DRB:

Dynamische Referenzklemme

HWK:

Halswirbelkörper

HWS:

Halswirbelsäule

iCT:

Intraoperative CT

LWS:

Lendenwirbelsäule

MRT:

Magnetresonanztomographie

SAS:

Subaxiale Instabilität

VT:

Vertikale Translokation

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Author information

Authors and Affiliations

  1. Schön Klinik Hamburg Eilbek, Klinik für Spinale Chirurgie, Hamburg, Deutschland

    R. Kothe

  2. Wirbelsäulenzentrum, St.-Josefs Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Deutschland

    M. Richter

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  1. R. Kothe
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Correspondence to M. Richter.

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Interessenkonflikt

M. Richter gibt an, dass er Autor eines zervikalen Implantatsystems der Firma Ulrich Medical, Ulm, Deutschland (Neon 2/3) ist und Lizenzgebühren erhält. Er erhält Beratungs- und Vortragshonorare von der Firma Brainlab, München. R. Kothe gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kothe, R., Richter, M. Relevanz der spinalen Navigation in der rekonstruktiven Halswirbelsäulenchirurgie. Orthopäde 47, 518–525 (2018). https://doi.org/10.1007/s00132-018-3568-x

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  • DOI: https://doi.org/10.1007/s00132-018-3568-x

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