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Iso-C3D-gestützte navigierte Implantation von Pedikelschrauben an BWS und LWS

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Zusammenfassung

Der mobile Siremobil® Iso-C3D (Siemens AG, Medical Solutions, Erlangen) erlaubt erstmals die intraoperative dreidimensionale (3D-) Erfassung knöcherner Strukturen. Es wird ein hochauflösender 3D-Datenkubus mit einer Kantenlänge von 12 cm erzeugt. Mittels des NaviLink™-Interface (Siemens AG, Medical Solutions, Erlangen) können die Daten in das Surgigate®-Navigationssystem (Medivision, Oberndorf, Switzerland) importiert werden. In der vorliegenden prospektiven Studie wird die Genauigkeit der Iso-C3D-Navigation bei der Platzierung von thorakalen und lumbalen Pedikelschrauben untersucht. Die Ergebnisse werden mit historischen Kontrollgruppen verglichen, in denen die Platzierung der Pedikelschrauben konventionell oder mithilfe anderer computerunterstützer Verfahren (CT-basierte Navigation, C-Bogen-basierte 2D-Navigation) erfolgte.

Bei 30 Patienten wurden insgesamt 141 Pedikelschrauben platziert (70 an der thorakale Wirbelsäule, 71 an der lumbale Wirbelsäule). Nur in einem einzigen Fall konnte im postoperativen Kontroll-CT eine inkorrekte Schraubenlage nachgewiesen werden, das entspricht einer Fehlplatzierungsrate von 0,71%, die geringste Rate aller Kollektive. Iso-C3D-Navigation war darüber hinaus die Methode mit der kürzesten Durchleuchtungszeit (1,28±0,56 min) bei vergleichbarer Gesamtoperationsdauer (103,26±23,3 min). Neurologische Komplikationen wurden postoperativ nicht beobachtet.

Aus diesen Ergebnissen schließen wir, dass die Iso-C3D-Navigation ein sehr präzises Verfahren zur Platzierung von Pedikelschrauben darstellt.

Abstract

The mobile Siremobil Iso-C3D C-arm (Siemens AG, Medical Solutions, Erlangen) is the first device that permits the intraoperative three-dimensional (3D) representation of bone structures. A high-resolution isotropic 3D data cube in the isocenter with an edge length of approximately 12 cm is calculated simultaneously. The Siremobil Iso-C3D is linked to navigation with the integrated NaviLink interface (Siemens AG, Medical Solutions, Erlangen). This makes it possible to transfer the generated 3D data directly to the linked navigation system Surgigate (Medivision, Oberndorf, Switzerland).

In this prospective clinical trial we evaluated the accuracy of pedicle screw placement using the Siremobil Iso-C3D C-arm. The results were compared to the conventional approach and other computer-assisted procedures (CT-based navigation, C-arm-based 2D navigation) in historical control groups.

A total of 141 pedicle screws were placed in 30 patients (70 thoracic spine, 71 lumbar spine). Only in one single case was misplacement shown in the postoperative control CT scan (0.71%), the lowest rate of incorrect placements of all techniques. Also the lowest average fluoroscopy time (1.28±0.56 min) was achieved during the placement of pedicle screws on the spine with Iso-C3D navigation at a comparable average OR duration (103.26±23.3 min). There were no postoperative neurological complications in all 30 patients.

From these data we conclude that Iso-C3D navigation of pedicle screws is a very accurate method in the correct placement of pedicle screws.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwigshafen

    K. Wendl, J. von Recum, A. Wentzensen & P. A. Grützner

  2. Berufsgenossenschaftliche Unfallklinik, Klinik für Unfall- und Wiederherstellungschirurgie, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen

    K. Wendl

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  1. K. Wendl
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  2. J. von Recum
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  3. A. Wentzensen
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  4. P. A. Grützner
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Correspondence to K. Wendl.

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Wendl, K., von Recum, J., Wentzensen, A. et al. Iso-C3D-gestützte navigierte Implantation von Pedikelschrauben an BWS und LWS. Unfallchirurg 106, 907–913 (2003). https://doi.org/10.1007/s00113-003-0683-9

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