Intraoperative O-arm navigation guided anterior cervical surgery; A technical note and case series

Abstract Background Navigation surgery is becoming very popular for anterior cervical surgery. However, one difficult problem for anterior cervical surgery is setting the reference frame (RF), due to the lack of reliable structures. If the RF is attached to the head holder or operation table instead of the patient, the accuracy of navigation is not good. Materials and methods This retrospective study included six patients who underwent anterior cervical surgeries with O-arm navigation. The RF was attached to the Caspar retractor using a special adaptor. Patients comprised three men and three women with a mean age of 62.8 years. Anterior cervical discectomy and fusion was performed in three cases, and anterior cervical corpectomy and fusion in three cases. We evaluated the accuracy of navigation, surgical time, intraoperative blood loss, complications, bony fusion, and clinical results. Results Mean accuracy of anterior navigation was 1.1 ± 0.7 mm (range, 0–2 mm). Mean surgical time and blood loss were 166 ± 39 min (range, 121–359 min) and 280 ± 189 ml (range, 50–600 ml), respectively. Complications comprised one case of postoperative C5 palsy that recovered within 6 months. Mean Japanese Orthopedic Association (JOA) recovery rate was 52.4% (range, 20–100%). Adequate decompression and solid fusion were obtained in all cases. Conclusions Intraoperative O-arm navigation-guided anterior cervical decompression and fusion is an effective technique for achieving precise decompression. This new navigation technique provides excellent results for severe cervical ossification of the posterior longitudinal ligament (OPLL) with minimum risk of adverse events from intraoperative radiation. We advocate the use of this novel technique in cases of cervical canal stenosis due to large disc osteophyte complex and OPLL, and also in cases of distorted cervical anatomy due to deformity, tumor, or revision surgery.