Minimally invasive posterior cervical microforaminotomy in the lower cervical spine and C-T junction assisted by O-arm-based navigation

Figures & data

Figure 1. T2-weighted MRI showing a right lateral soft disc herniation at C7-T1 (red arrow). Left: sagittal foraminal view; center: axial view; right: CT axial view.

Figure 2. Operating room setting. (1) Intraoperative CT scan being performed with O-arm; (2) navigation monitor; (3) infrared camera system (IFS); (4) NIM (neural integrity monitor); and (5) dynamic reference base (DRB).

Table I.  O-arm workflow.

Procedure	Time (min)
Draping	3
Moving O-arm into surgical field/  ensuring camera visibility	6
Scanning	1
Parking O-arm	3
Uncovering sterile drape	1
Ready to go	14
Total	28

Figure 3. Left: Preoperative radiograph showing the difficulty in finding the correct level (C6-7 level) for the surgical approach. Right: O-arm navigation images allowing proper localization of the level and laminofacet junction.

Figure 4. Left: A 1.6-cm skin incision for one-level decompression. Right: A 2.0-cm skin incision for two-level decompression.

Figure 5. Postoperative posterior view of a 3D CT scan showing the small keyhole for decompression of a C6-7 left foraminal stenosis and demonstrating adequate preservation of facet joints.

Table II.  Demographics for posterior cervical microforaminotomy assisted by O-arm-based navigation.

Case number	Sex	Age	Operated levels	Side	Intraoperative bleeding (cc)	Operation time (min)
1	M	49	C6-7/C7-T1	Left	200	190
2	M	53	C6-7	Left	50	120
3	F	67	C6-7	Left	130	140
4	M	48	C6-7	Left	170	85
5	M	45	C6-7	Left	120	115
6	M	52	C6-7	Left	50	140
7	M	57	C6-7	Left	120	95
8	M	43	C6-7	Left	150	195
9	M	52	C6-7	Right	130	100
10	M	54	C6-7	Right	80	115
11	M	40	C6-7/C7-T1	Left	250	200
12	M	37	C6-7	Right	90	140

Figure 6. Intraoperative O-arm images used to check the adequacy of decompression. A foraminal view (lower right) can be obtained to evaluate the remnant foraminal stenosis.