Interdisciplinary Neurosurgery (Jun 2021)
Using 3D navigation in sitting position in dorsal stabilization for traumatic cervical fracture–dislocations in an emergency situation: A Case series and technical notes
Abstract
Introduction: Fracture–dislocations of the cervical spine are potentially serious injuries. The goal of management is adequate reduction and stabilization, and usually, surgery is required. Combined anterior–posterior stabilization is recommended if either approach is suboptimal. Spinal navigation has become safer, more accurate, and more popular among spine surgeons. Most of the published studies used spinal navigation in cervical fracture cases in the prone position, with the head fixed to the MAYFIELD® frame. Spinal navigation in the sitting position is less popular among spine surgeons. Navigation in the sitting position is a challenge regarding operating room setup, the camera position, and the site of the reference arc. Case presentation: This is a report of five clinical cases of traumatic cervical fracture–dislocations. All patients underwent emergent posterior dorsal stabilization using 3D navigation in the sitting position. Elective anterior cervical discectomy and fusion (ACDF) was performed in the second session in 3 cases. We present our experience, including technical notes, in the management of cervical fracture–dislocations using spinal navigation in the sitting position. Postoperative course showed improvement in all cases, with stabilization of the cervical spine. Conclusions: The use of intraoperative navigation can reduce the rate of displacement of screws and provide relatively secure access to the cervical neural element. The sitting position is a possible safe method with less bleeding, good visualization with lowering of the arms, and better blood circulation for treating a complex cervical fracture. The experience of the surgeon, standard protocol, and advanced technology help in properly managing complicated emergent cases of cervical fractures.
