Navigation assisted tubular resection of lumbar osteoid osteoma: how I do it
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HOW I DO IT - SPINE DEGENERATIVE
Navigation assisted tubular resection of lumbar osteoid osteoma: how I do it Gianpaolo Jannelli 1
&
Alessandro Moiraghi 1,2 & Karl Schaller 1 & Enrico Tessitore 1
Received: 12 March 2020 / Accepted: 27 May 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Osteoid osteoma is a benign primary bony tumor involving the spinal posterior arches. Surgical treatment is reserved to patients with severe pain or not responding to nonsteroidal anti-inflammatory medications. We report a minimally invasive transmuscular resection of an L5 isthmic osteoid osteoma, assisted by intraoperative 3D-fluoroscopy-based navigation. Methods Navigation tracking reference is placed on the spinous process. A simil-scan with 3D-fluoroscopy is obtained to allow autoregistration for spinal navigation. Tubular transmuscular approach, directed to the ipsilateral isthmus and pedicle, is performed. Under navigation guidance, the lesion is identified and removed. Conclusion This technique is a safe and effective minimally invasive alternative to conventional surgical treatment of lumbar osteoid osteoma. Keywords Osteoid osteoma . 3D-fluoroscopy . Navigation . Transmuscular approach
Introduction and relevant surgical anatomy Osteoid osteoma is a benign bone-forming tumor, representing 5% of all bone tumors [8]. On plain film, the lesion appears as a small, round, radiolucent nidus with surrounding sclerosis. Thin-slice computed tomography scan (CT) is effective in identifying the anatomic location of the nidus and is considered the imaging modality of choice. Magnetic resonance imaging (MRI) is helpful to evaluate the perilesional edema [2] (Fig. 1). Surgical treatment is an option for patients with severe pain and those not responding to salicylates or other nonsteroidal anti-inflammatory medications [8]. Lesion This article is part of the Topical Collection on Spine degenerative Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04443-1) contains supplementary material, which is available to authorized users. * Gianpaolo Jannelli [email protected] 1
Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
2
Service de Neurochirurgie, GHU Paris, Hôpital Sainte-Anne, F-75014 Paris, France
resection with a minimally invasive transmuscular approach, performed under navigation guidance, could associate excellent functional outcomes with rapid recovery and a low risk of secondary instability. A correct identification of the spinal process on the involved vertebra with intraoperative 2D-fluoroscopy is mandatory to obtain a stable placement of navigation tracking reference. In far lateral transmuscular approach, the most important anatomical landmark is the lateral border of the isthmus. The isthmus, or pars interarticularis, is the segment of posterior vertebral arch in between two articular processes of the spine. Anatomical
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