Is there a need for navigation guided disc replacement?

[Justin]

Surgical Neurology
Volume 71, Issue 1, January 2009, Page 149

Is there a need for navigation guided disc replacement? (Poster Session)

G. Alessia, B. Liua, B. Noensa, B. D'Haena, H. Collea and L. Dewaelea
aAZ St Lucas, Ghent

Introduction

Total lumbar disc replacement has become a rapidly growing technology in treating degenerative disk disease. The malpositioning of the prosthesis can be one of complications that is surgeon related. Recently, it has been shown that navigation system may assist the surgeon in conforming precise positioning during the procedure. It would provide superior imaging data compared with conventional intraoperative imaging technology in spine surgery.

Study design

The authors performed a prospective study involving randomized radiological assessment for confirming the coronal midline positioning in lumbar arthroplasty and try to provide the most precise guidance.

Purpose

The aims of the study are to check the accuracy of the placement of the prosthesis during surgery and to check if accuracy and precision of the placement intraoperatively could be improved by navigation and thus enhance the safety of the procedure.

Materials and method

Total lumbar disk replacement with Prodisc© L prosthesis was performed by anterior retroperitoneal approach at all cases with single level. Two image guide techniques were used on 20 patients: 10 cases were operated with navigation and 10 cases with standard fluoroscopy guidance. Midline positioning is performed either with the navigation pointer (Fig. 1), either with radiological assessment of a needle on the supposed midline. Postoperatively, the prosthesis midline was assessed with computed tomography and conventional radiography. The interpedicular line was drawn on the axial plane image; the midpoint of this line was considered as reference midline. The line through the keel of the prosthesis should be perpendicular to the interpedicular line. The actual midline positioning of each patient was defined as the offset distance of the prosthesis keel from the interpedicular midpoint and perpendicular to the interpedicular line.

Results

In midline positioning of prosthesis, similar results were found between the 2 groups. Mean deviation from the midline in both groups was similar (1.3 mm with conventional fluoroscopy, 1.5 with navigation). With navigation, there was a considerable prolongation of the operating time (mean of 113 minutes with navigation, mean of 83 minutes with fluoroscopy). No adverse effects were noted in either group.

Conclusions

Navigation-assisted midline marking has in our opinion an important advantage for the surgeon during the learning curve of spine arthroplasty surgery. More experienced surgeons will find no significant advantage with navigation.

Copyright © 2008 Published by Elsevier Inc.