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New 3-D Image Method for Cervical Spine Surgery

Minimally invasive surgery (MIS) of the cervical spine (neck) is limited to the lab for right now. The cost of new technology to accomplish this must be matched or exceeded by benefits. In this study scientists use three-dimensional (3-D) fluoroscopy (X-ray imaging) to place cervical spine screws. This technology allows the surgeon to use small incisions through the skin. This is called percutaneous placement.

This type of operation is already being used in the lumbar spine. But using MIS in the cervical spine is a little trickier. Standard fluoroscopy doesn't always show the details of the bones. The smallest mistake could result in nerve or spinal cord damage. That's why practicing this technique on cadavers is important before trying it on live patients.

The new 3-D fluoroscopy is combined with computer assistance. It gives the surgeon anatomic views in 3-D to guide the placement of screws. The goal is to improve accuracy and reduce complications. The imaging machine is a C-shape arm that can be rotated in a 190-degree arc around the patient. The surgeon uses a foot pedal to move the arm.

One incision site was used to place screws at two spinal levels. A drill guide was inserted through the soft tissues into the bone using the 3-D technology. Screws were passed through the guide. Intraoperative scans showed that 41 of the 42 screws were accurately placed.

The authors say this new technology has many advantages over standard CT imaging. It is more efficient because it allows the surgeon to skip some steps in the operation. The scan automatically transmits images of all the vertebra instead of one at a time allowed with standard CTs.

Navigation error is reduced with 3-D fluoroscopy because the patient can be scanned in the desired position for surgery. Images are available for viewing right away. Cost and training time are the two biggest drawbacks. More study is needed to define the best use of this new technology.

References: Langston T. Holly, MD, and Kevin T. Foley, MD. Percutaneous Placement of Posterior Cervical Screws Using Three-Dimensional Fluoroscopy. In Spine. March 1, 2006. Vol. 31. No. 5. Pp. 536-540.

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