Abstract
We report the use of a navigation system for upper cervical fusion with details of its utilities and problems. Between March 2005 and July 2010, we treated 49 cases (including 2 multiple operation cases) using this system. From March 2005 to March 2009, CT-based navigation was used, and for the latter period Iso-C 3D navigation was employed. The average patient age at the time of surgery was 63 years. There were 18 trauma patients and 31 non-trauma patients. Transarticular screw fixation (the so-called Magerl technique) was applied for 26 cases, C1 lateral mass screw and cervical pedicle screw fixation for 7 cases, and occipital screw fixation for 6 cases. The deviation of the inserted screw after surgery assessed by CT scan and complications of upper cervical fusion were investigated.
We experienced one case of transarticular screw deviation in high-riding VA patients, avoiding VA injury. Exclusion criteria for transarticular screw fixation should be established in order to avoid VA injury. One complication of posterior fusion was non-union, seen in 2 cases. No neurological deterioration occurred. In cases of non-union, we used C1 lateral mass screw fixation in patients with rheumatoid arthritis (RA). In conclusion, the use of transarticular screws and a navigation system is the first choice for upper cervical fixation.
