Acta Neurochirurgica

, Volume 156, Issue 9, pp 1807–1812 | Cite as

Intraoperative portable CT-scanner based spinal navigation - a feasibility and safety study

  • Pavel Barsa
  • Robert Frőhlich
  • Vladimír BenešIII
  • Petr Suchomel
Clinical Article - Spine



Navigation based on an intraoperative CT scan is not a new approach to spinal instrumentation. Innovative intraoperative imaging technology, however, opens new horizons to more precise image acquisition as well as to further workflow. Planning of screw entry-points and trajectories in this study had been based on intraoperative imaging obtained by a portable 32-slice CT scanner. This prospective study evaluates feasibility, accuracy, and safety of this novel approach in an initial series of 85 surgeries.


Medical records and radiological materials of 82 patients who underwent the first 85 consecutive stabilisations were analysed. Incorrect screw position, medical and technical complications as well as availability of this procedure in particular spinal levels were the subject of evaluation.


Out of 571 implants inserted in all spinal levels, only five screws (0.87 %) did not meet the criteria for correct implant position. These screw misplacements had not been complicated by neural, vascular or visceral injury and the surgeon was not forced to change the position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging sufficient for navigation was obtained at all spinal segments regardless of a patient’s habitus or positioning or comorbidity.


Intraoperative portable CT scanner-based navigation seems to be an effective way of doing spinal instrumentation guidance. High precision of implant insertion confirms the preconditions of navigation usage during more complex surgeries at any level of the spine.


Spinal instrumentation Surgical navigation Intraoperative imaging Computed tomography Portable CT scanner 



computed tomography


light emitting diode




computed tomography dose index


dose length product


Conflicts of interest



  1. 1.
    Golfinos JG, Fitzpatrick BC, Smith LR, Spetzler RF (1995) Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197–205PubMedCrossRefGoogle Scholar
  2. 2.
    Willems PW, van der Sprenkel JW, Tulleken CA, Viergever MA, Taphoorn MJ (2006) Neuronavigation and surgery of intracerebral tumours. J Neurol 253:1123–1136PubMedCrossRefGoogle Scholar
  3. 3.
    Nolte LP, Zamorano LJ, Jiang Z, Wang Q, Langlotz F, Berlemann U (1995) Image-guided insertion of transpedicular screws. A laboratory set-up Spine 20:497–500Google Scholar
  4. 4.
    Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomized controlled clinical study in 100 consecutive patients. Eur Spine J 9:235–240PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Waschke A, Walter J, Duenisch P, Reichart R, Kalff R, Ewald C (2013) CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J 22:654–660PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Fan Chiang CY, Tsai TT, Chen LH, Lai PL, Fu TS, Niu CC, Chen WJ (2012) Computed tomography-based navigation-assisted pedicle screw insertion for thoracic and lumbar spine fractures. Chang Gung Med J 35:332–338PubMedGoogle Scholar
  7. 7.
    Steudel WI, Nabhan A, Shariat K (2011) Intraoperative CT in spine surgery. Acta Neurochir (Wien) Suppl 109:169–174CrossRefGoogle Scholar
  8. 8.
    Tonn JC, Schichor C, Schnell O, Zausinger S, Uhl E, Morhard D, Reiser M (2011) Intraoperative computer tomography. Acta Neurochir (Wien) Suppl 109:163–167CrossRefGoogle Scholar
  9. 9.
    Costa F, Cardia A, Ortolina A, Fabio G, Zerbi A, Fornari M (2011) Spinal navigation: standard preoperative versus intraoperative computed tomography data set acquisition for computer-guidance system: radiological and clinical study in 100 consecutive patients. Spine 36:2094–2098PubMedCrossRefGoogle Scholar
  10. 10.
    Kosmopoulos V, Theumann N, Binaghi S, Schizas C (2007) Observer reliability in evaluating pedicle screw placement using computed tomography. Int Orthop 31:531–536PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Amiot LP, Lang K, Putzier M, Zippel H, Labelle H (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar and sacral spine. Spine 25:606–614PubMedCrossRefGoogle Scholar
  12. 12.
    Fraser J, von Jako R, Carrino J, Härtl R (2008) Electromagnetic navigation in minimally invasive spine surgery: results of a cadaveric study to evaluate percutaneous pedicle screw insertion. SAS J 2:43–47CrossRefGoogle Scholar
  13. 13.
    von Jako R, Finn MA, Yonemura KS, Araghi A, Khoo LT, Perez-Cruet M (2011) Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system. Acta Nerochir (Wien) 153:589–596CrossRefGoogle Scholar
  14. 14.
    Sasso RC, Garrido BJ (2007) Computer-assisted spinal navigation versus serial radiography and operative time for posterior spinal fusion at L5-S1. J Spinal Disord Tech 20:118–122PubMedCrossRefGoogle Scholar
  15. 15.
    Papadopoulos EC, Girardi FP, Sama A, Sandhu HS, Cammisa FP Jr (2005) Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J 5:263–267PubMedCrossRefGoogle Scholar
  16. 16.
    Bandela JR, Jacob RP, Arreola M, Griglock TM, Bova F, Yang M (2013) Use of CT-based intraoperative spinal navigation: management of radiation exposure to operator, staff, and patients. World Neurosurg 79:390–394PubMedCrossRefGoogle Scholar
  17. 17.
    Ringel F, Villard J, Ryang YM, Meyer B (2014) Navigation, robotics and intraoperative imaging in spinal surgery. Adv Tech Stand Neurosurg 41:3–22PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Pavel Barsa
    • 1
  • Robert Frőhlich
    • 1
  • Vladimír BenešIII
    • 1
  • Petr Suchomel
    • 1
  1. 1.Department of NeurosurgeryRegional Hospital of LiberecLiberecCzech Republic

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