Usefulness of Spinal Navigation in Cervical MIS Surgery

A new technique of percutaneous minimally invasive cervical pedicle screw (MICEPS) fixation of the upper cervical spine as well as subaxial cervical spine via a posterolateral approach using intraoperative CT-guided navigation was introduced. Bilateral skin incisions are made for screw insertion under navigational guidance. The lateral mass is exposed with blunt dissection, and a 1.4-mm guide wire is inserted obliquely from the pilot hole in the pedicle to the vertebral body using a navigated guide tube and power drill driver. A drill, a tap, and a cannulated pedicle screw (PS) are inserted sequentially over the guide wire. Facet fusion is performed through this posterolateral approach. When the C1 lateral mass is exposed, there are two ways to deal with the oblique capitis inferior (OCI) muscle. One is above OCI approach, another is below OCI approach. This method provided direct oblique exploration of C1–C7 lateral masses and allowed the correct oblique angle of the screw position, which resulted in less lateral deviation and subsequently reduced muscle damage and bleeding from the venous plexus.