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Wirbelsäulenverletzungen und Unfallfolgezustände

Navigierte Operationsverfahren

Spinal injuries and accident sequelae

Navigation-assisted surgical methods

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Computerunterstützte Verfahren sollen die intraoperative Orientierung erleichtern, die Genauigkeit erhöhen, die Invasivität vermindern und die Emission von ionisierenden Strahlen reduzieren. In der Traumatologie werden sie seit über 15 Jahren eingesetzt. Es existieren im Wesentlichen 3 Formen der Navigation: CT-basierte (CT: Computertomographie) Navigation, die auf einem präoperativen CT fußt, 2D-Navigation, die auf C-Arm-Bildern beruht, sowie 3D-Navigation, deren Grundlage ein intraoperativer 3D-Scan ist. In der Literatur sind die überlegene Genauigkeit für Instrumentierungen an der Lenden- und der Halswirbelsäule belegt, ebenso eine Reduktion der Emission ionisierender Strahlung. Ein Beweis für eine erhöhte Genauigkeit im Bereich der Brustwirbelsäule steht an größeren Kollektiven und mit prospektiven Studiendesigns noch aus. Navigation kann ein wertvolles Instrument zur Visualisierung der nur schwer exponierbaren und intraoperativ radiologisch darstellbaren Anatomie der Wirbelsäule (WS) sein, in jedem Fall müssen jedoch die klassischen Techniken beherrscht werden. Die intraoperative 3D-Scan-Technologie mit automatischer Registrierung ist als Goldstandard der WS-Navigation anzusehen.

Abstract

The aim of computer-assisted navigation procedures is to increase the anatomical orientation intraoperatively, to improve the accuracy, to minimize the invasiveness and to reduce the emission of radiation. In the field of orthopedic surgery navigation has been used for over 15 years and these techniques are particularly widely used in spinal surgery. There are three major applications of navigation: CT-based (computed tomography) navigation which needs a preoperative CT scan, 2D navigation which is based on standard X-ray images of a C-arm during surgery and 3D navigation which requires an intraoperatively performed C-arm based 3D scan. Higher accuracy has been proven for instrumentation of the lumbar and cervical spine and reduced emission of radiation could be demonstrated. Higher accuracy for pedicle screw insertions of the thoracic spine is still not proven in prospective studies with sufficient numbers of pedicle screws. Navigation systems provide additional information for better anatomical orientation in spinal surgery and can reduce intraoperative fluoroscopy time. Intraoperative 3D scan technology with automatic registration is the perfect tool in spinal surgery today. Knowledge of the classical techniques remains crucial for the safety of patients.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Zentrum für Chirurgie, Universitätsklinik Ulm, Steinhövelstraße 9, 89075, Ulm, Deutschland

    M. Kraus, M. Schultheiß & F. Gebhard

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  1. M. Kraus
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  2. M. Schultheiß
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  3. F. Gebhard
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Correspondence to M. Kraus.

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Kraus, M., Schultheiß, M. & Gebhard, F. Wirbelsäulenverletzungen und Unfallfolgezustände. Trauma Berufskrankh 12, 78–87 (2010). https://doi.org/10.1007/s10039-010-1615-x

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