Application And Clinical Evaluation Of Computer-assisted Navigation Technology Based On O-arm? In Spinal Surgery

Background:In spinal surgery,the surgeon’s solid anatomical knowledge and skilled surgical techniques play a fundamental and critical role.For the control of surgical accuracy,the traditional methods depend more on the knowledge and experience of the doctors,some of them depend on the 2-dimensional imaging such as intraoperative fluoroscopy.With the development of science,the appearance of intraoperative 3-dimensional imaging system and computer-assisted navigation technology revolutionized spinal surgery,and make it digitized,precision and minimally invasive.Compared with the traditional surgical methods,the computer-assisted navigation technology based on the intraoperative three-dimensional imaging system can help surgeons to obtain clear 3-dimensional images,at the same time,under the computer-assisted,it can match the images with the surgical instruments and display the relative position between the surgical instruments and the anatomic structure in real time,and guide the doctors’ operation.Although the technique has advantages in improving the accuracy of surgery,reducing the difficulty of surgery and reducing the exposure of medical staff,most of the current research is still focused on pedicle screw placement.Further clinical studies are needed to evaluate the feasibility and clinical effect of this technique in other areas of spinal surgery.Part one:Clinical evaluation of computer-assisted navigation technology based on O-arm? in unilateral open-door cervical expansive laminoplastyObjective:To explore the feasibility of computer-assisted navigation technology based on O-arm? in unilateral open-door cervical expansive laminoplasty and evaluate its clinical effect.Methods:From May 2014 to October 2017,26 cases suffering from cervical spinal stenosis underwent unilateral open-door cervical expansive laminoplasty with computerassisted navigation technology based on O-arm?.The electronic medical records and images were reviewed.Operation parameter such as operative Time,amount of bleeding during operation were recorded.Japanese orthopedic association(JOA)score(17 points)was evaluated at pre-operation and final follow-up.The imaging results of 6 months after operation were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.Results: The average operation time was 162.2min±24.0min;the average intraoperative blood loss was 282.7ml±117.0ml;no complication was noted during operation.All patients were followed up for 6.0 months-46.4 months(mean 22.8 months).The average JOA score for preoperation was 8.1±2.7 and 13.4±2.7 at final follow-up.All patients’ clinical symptoms were improved in varying degrees(P<0.05),with the improvement rate of 58.2%±30.4%.Except for one patient who did not reach the follow-up time,the imaging data of the other patients,at 6 months after operation,showed satisfactory enlargement of the spinal canal and bony fusion at hinge side without recurrence of cervical stenosis and neurofunction deterioration.Conclusion: It is safe and feasible to apply the computer-assisted navigation technology based on O-arm? in unilateral open-door cervical expansive laminoplasty,and the clinical effect is satisfactory.Part two: Clinical evaluation of computer-assisted navigation technology based on O-arm? in Mis-Tlif with bilateral decompression via a unilateral approachObjective:To explore the feasibility of computer-assisted navigation technology based on O-arm? in Mis-Tlif with bilateral decompression via a unilateral approach and evaluate its clinical effect.Methods:From June 2015 to January 2016,A total of 17 patients,6 males and 11 females,were diagnosed as "degenerative lumbar spondylolisthesis associated with spinal stenosis" and underwent mis-tlif surgery and bilateral decompression via a unilateral approach that was performed with a novel working retractor with an endoscopic system under navigation.Gender,age,and surgical segments were recorded.Operation parameter such as operative Time,amount of bleeding during operation were also recorded.Visual analogue score(VAS)of low back pain and leg pain,Japanese Orthopedic Association(JOA),Oswestry disability index(ODI)were evaluated at pre-operation and 1 year follow-up.Results:All patients at 1 year follow-up showed clinical improvement,based on the visual analog scale,Oswestry Disability Index,and Japanese Orthopaedic Association score(P < 0.01).At 12 months postoperatively,all patients achieved solid bone graft fusion.Conclusion: The use of navigation-assisted Mis-Tlif with bilateral decompression via a unilateral approach appears safe and feasible.The endoscopic surgical procedure may be an alternative surgical option for degenerative lumbar disease.