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F Costa , M Tomei, M Sassi, A Cardia, A Ortolina, M Fornari

EVALUATION OF THE RATE OF DECOMPRESSION IN ANTERIOR CERVICAL CORPECTOMY USING AN INTRA-OPERATIVE CT SCAN (O-ARM SYSTEM). F Costa , M Tomei, M Sassi, A Cardia, A Ortolina, M Fornari. Indications. Severe Cervical Stenosis exceding the osteophitic disc levels Instability of Cervical Spine

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F Costa , M Tomei, M Sassi, A Cardia, A Ortolina, M Fornari

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  1. EVALUATION OF THE RATE OF DECOMPRESSION IN ANTERIOR CERVICAL CORPECTOMY USING AN INTRA-OPERATIVE CT SCAN (O-ARM SYSTEM). F Costa, M Tomei, M Sassi, A Cardia, A Ortolina, M Fornari

  2. Indications Severe Cervical Stenosis exceding the osteophitic disc levels Instability of Cervical Spine Ossified Posterior Longitudinal Ligament (OPLL) Age of patient (< 70 years) Mild/Severe clinical picture (spasticity and/or tetraplegia)

  3. Somatectomy The surgical technique is demanding and sometimes decompression is insufficient The completeness of bone removal can be assessed by an intra-operative CT scan. If the bone removal is inadequate, additional bone can be removed Freidberg SR et al. Intraoperative computerized tomography scanning to assess the adequacy of decompression in anterior cervical spine surgery. J Neurosurg. 2001 Jan; 94 (1 Suppl): 8-11.

  4. Materials And Methods Pre-operative Assessment Cervical NMR Cervical CT scan (optional) Dynamic X-ray (optional) Neurological Evaluation Intra-operative Assessment Cervical CT scan (O-arm)

  5. Population September 2009 – December 2010 15 Cervical Somatectomy 9 Males - 6 Female Mean Age 52.4 years 9 patients: 1 level of somatectomy 6 patients: 2 levels of somatectomy

  6. Population

  7. O-arm 3D system, based on intra-operative CT scan ADVANTAGES: Absolute Accuracy Automatic Acquisition and Recognition with Neuronavigation 3D Continuous Navigation Reduction of Surgical Time (no necessity to recognize anatomical markers) Quick Possible to perform an intra-operative control DISADVANTAGES: Dimension Costs

  8. Results Adequate bone removal11 patients 73.3% Further bone removal required 4 patients 26.7%

  9. Clinical Case

  10. Clinical Case Intra-operative CT: good ad extended decompression Intra-operative CT: correct position of screws and plate

  11. Conclusions Intraoperative CT scan performed with O-arm during corpectomy is a useful tool and allows: To evaluate the complete bone removal and then the adequacy of surgery To control the correct position of bone graft and screws/plate

  12. All the Authors are aware of the content of the paper and do not have any financial or other interests that might be construed as a conflict of interest. No funds were received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other foundation(s) requiring open access.

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