Professor of Neurosurgery, Director of Spinal Oncology Roswell Park Comprehensive Cancer Center Buffalo, New York, United States
Introduction: Primary spinal column tumors often require spinal instrumentation with tumor resection. Serial imaging is key to assessing treatment response and recurrence surveillance. Titanium spinal instrumentation creates significant artifact on MRI and CT that makes close surveillance difficult due to artifact. Carbon fiber coated pedicle screws have been recently approved for use by the FDA and create less imaging artifact. The authors describe a technique for incorporating carbon fiber instrumentation into a spinal neuronavigation platform, a method that has not previously been described. We describe a unique technique for incorporating carbon fiber coated pedicle screws into a spinal neuronavigation platform for accurate instrumentation placement.
Methods: Technical Note
Results: A patient presented with severe back pain and myelopathy requiring assistance for ambulation. MRI demonstrated significant spinal cord compression at T10 with cord signal change secondary to a progressively growing vertebral body and laminar mass. Given need for long-term MRI surveillance, carbon fiber instrumentation was decided to be used. Following posterior element exposure, the reference arc was attached to the inferior most spinous process. Intraoperative 3D CT imaging was obtained, and pilot holes were made with the drill. Navigated spinal taps were utilized to create pedicle screw tracks. Pedicle screws were immediately placed after each tap. Carbon fiber coated screws are not able to be individually navigated but the navigated tap holes created a reliable tract for the screws. Repeat 3D CT imaging demonstrated accurate screw placement. The carbon fiber pedicle screws were less apparent on intraoperative CT images than typical titanium pedicle screws, but a reliable halo was observed. Final pathology was hemangioma. Postoperative MR imaging revealed a decompressed spinal cord not obscured by instrumentation.
Conclusion : Carbon fiber coated pedicle screws can be safely be placed with integration of spinal neuronavigation platforms which allow clearer postoperative imaging which is helpful for surveillance of oncological pathologies.
