Image-guided anterior cervical corpectomy - A feasibility study

Study Design. A feasibility study was performed to determine the efficacy of using image-guided frameless stereotaxy to perform anterior corpectomy of the cervical spine. Objective. To assess the feasibility of using image-guided stereotaxy in performing anterior cervical corpectomy. Summary of Background Data. Anterior cervical decompression including discectomy and corpectomy is a commonly performed procedure. Particular concern about invasion of the vertebral artery arises while performing this procedure to gain maximal lateral decompression. At present, surgeons have only landmarks and experience to guide them in performance of this potentially dangerous procedure. Methods. Four cadavers (average age, 40.3 years) were used. A lateral corpectomy trough was created in Group 1 by a standard technique using visual landmarks. In the second group of corpectomy troughs, an image-guided frameless stereotactic system was used. After completion of the experiment, each cadaver had a corpectomy trough at every level on one side performed in a standard manner and on the other with image guidance. Using the image guidance system, an independent observer measured the distance from the corpectomy trough (lateral border) to the medial border of the foramen transversarium. Results. The average distance from the lateral border of the trough to the medial border of the foramen transversarium in the standard trough group was 5.10 mm (range, 1.72-7.71 mm), and the average distance from the medial border of the foramen transversarium to the image-guided trough was 4.34 mm (range, 3.34-5.48 mm). The trend of the comparison between the two troughs was toward significance at P = 0.08. Conclusions. Image-guidance provided improved accuracy when compared with that of a standard technique, implying clinical potential for image-guided corpectomy. Less variability is seen using an image-guided approach.