Safety and Efficacy of Reconstruction of Complex Cervical Spine Pathology Using Pedicle Screws Inserted with Stealth Navigation and 3D Image-Guided (O-Arm) Technology

Study Design. Retrospective analysis. Objective. To determine safety and efficacy of cervical pedicle screw placement using O-Arm and Stealth Navigation in patients with cervicothoracic spinal deformities and revision subaxial cervical pathology. Summary of Background Data. Cervical pedicle screws are biomechanically advantageous to other posterior cervical fixation techniques; however, their use is limited by concerns for neurovascular injury. Few clinical reports exist on their placement safety and efficacy using modern navigation systems. Methods. Adults who had cervical pedicle screws inserted using O-Arm and Stealth Navigation between November 2007 and January 2014 and with a minimum 1-year follow-up were retrospectively studied. Screw insertion safety, surgical complications, need for reoperation, and clinical outcomes [Neck Disability Index, EQ-5D, numeric pain rating scales] were evaluated. Results. 21 patients (female-10; male-11; average age 63 yr [32-83 yr]) met inclusion criteria. Average follow-up was 29.8 months (12-81.6 mo). Reconstruction of C2 and the subaxial cervical spine included 8 primary operations for cervicothoracic kyphosis and 13 revision operations. 121 pedicle screws were placed (C2: 4, C3: 20, C4: 22, C5: 23, C6: 18, C7: 34) using Stealth Navigation. The average number of screws placed per case was 6 (1-12). Greater than 99% of screws were placed safely without neurovascular injury. 1 screw (0.8%) was noted postoperatively to critically breach the medial wall and was associated with an acute C5 nerve root palsy. 2 patients required revisions for postoperative iatrogenic foraminal stenosis and associated C8 radiculopathies. No vascular complications due to aberrant screw placement occurred. There were significant improvements (P < 0.05) in EQ-5D utility scores and neck and arm pain. Neck Disability Index scores decreased on average by 10 points (P = 0.12). Conclusion. Placement of cervical pedicle screws using O-Arm/Stealth Navigation in this series was a safe and effective method for posterior stabilization in cervicothoracic deformity and revision operations of the subaxial cervical spine. Level of Evidence: 4