Navigation an der Halswirbelsäule

Zusammenfassung

Wie in allen anderen Abschnitten der Wirbelsäule gewinnt die intraoperative Navigation auch im Bereich der Halswirbelsäule zunehmend an Bedeutung. Die Nähe der neurovaskulären Strukturen, die komplexe Anatomie des 1. und 2. Halswirbelkörpers und die Einführung von minimalinvasiven Verfahren erschwert die sichere Schraubenplatzierung im Bereich der Halswirbelsäule. Etablierte und neuere navigierte Verfahren zielen darauf ab, die Genauigkeit bei der Schraubenplatzierung immer weiter zu erhöhen. Alle gängigen Operationen im Bereich der Halswirbelsäule können auch navigiert durchgeführt werden und zeigen im Vergleich zur konventionellen Technik niedrigere Fehllageraten. Von den zur Verfügung stehenden Verfahren zeigt die 3-D-Navigation mit einem intraoperativ generierten Bilddatensatz die höchste Genauigkeit. Die Benutzung von aus den CT-Daten modellierten Templates und roboterassistierten Verfahren muss sich gegenüber den etablierten Verfahren in großen Studien noch beweisen, stellt aber für die Zukunft eine weitere Möglichkeit dar, die Genauigkeit der Schraubenplatzierung an der Halswirbelsäule zu verbessern.

Abstract

Intraoperative navigation for procedures of the cervical spine (C I – C VII) is increasingly focused on its complex anatomy, the risk of neurovascular injury and the increasing importance of minimal invasive approaches. Computer-assisted surgery aims to improve the accuracy of screw placement in the cervical spine. All of the established conventional procedures, including transarticular C I and C II screw placement (Magerl technique), odontoid screw placement, C I and C II stabilisation (Harms technique) or pedicle screw placement in the upper and subaxial spine can be achieved using intraoperative navigation. For these procedures, studies have shown lower malposition rates for computer-assisted surgery, with the highest accuracy for 3-D-based compared to CT-based and fluoroscopy-based navigation. The use of prototyping drill templates and robot-assisted screw placement shows promising results in small studies and case reports but its value has to be further evaluated with high-level evidence clinical studies.

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