A Novel Technique for Intraoperative Navigation in Occipitocervical Fusion: A Preliminary Report.

BACKGROUND: Intraoperative navigation improves screw placement accuracy in pediatric occipitocervical fusion. All reports of navigated occipitocervical fusion using occipital plates in any age patient describe navigation placed at case onset to guide occipital and cervical fixation, or navigation placed at case onset to guide cervical screw placement alone before occipital fixation. We describe a novel technique for navigated occipitocervical fusion and analyze short-term outcomes in a pediatric case series.

METHODS: We describe a novel technique for occipitocervical fusion using intraoperative navigation with the reference array attached to the occipital plate after occipital plate fixation, before distal instrumentation. Navigation was used for subaxial fixation only, and not for occipital fixation. A retrospective review of cases treated with this technique was conducted to summarize patient and surgical variables.

RESULTS: Three pediatric (median; 4 y) patients underwent occipitocervical fusion using the described technique. There were no intraoperative complications related to navigation, including the need for repeat spin, movement of the array, inaccurate navigation, or loss of navigation. There were no intraoperative complications related to occipital fixation, including dural leak, venous sinus penetration, or dislodgement of instrumentation.

CONCLUSIONS: This technique is successful in obtaining occipitocervical fusion in complex patients, with no navigation-related or fixation-related complications in the intraoperative or postoperative period. This technique has the potential to reduce operative time and navigation-related complications, as well as improve patient safety and construct alignment.

LEVEL OF EVIDENCE: Level IV.