Preliminary application of intraoperative three-dimensional CT scanning with integrated navigation system in spinal surgery Orthopedic Hospital of the General Hospital of the People’s Liberation Army . BEIJING 100853 OBJECTIVE: To explore the effect of intraoperative 3D CT scanning with integrated navigation system in spine surgery, including the feasibility of this equipment application, workflow and image quality. METHODS: A sliding 40-slice CT scanner (Somatom Sensation, Germany) was installed in a prefabricated operating room. Surgical patients were placed on a surgical bed (Trumpf, Germany) that was X-ray permeable, able to pass through the CT scan aperture, and movable in all positions. For occipitocervical or cervical spine surgery, the patient’s head can be immobilized using an X-ray permeable charcoal fiber head frame. The CT scanner is slid along the patient during image acquisition. The CT is connected to an infrared wireless navigation system (BrainLab). When the navigation system is needed, the data from the CT scan can be converted into three-dimensional images and transmitted to the navigation system at any time for real-time intraoperative navigation. 118 patients with spinal disorders were treated from April 13, 2009, to September 1, 2009, using intraoperative three-dimensional CT scanning and navigation systems. RESULTS: In the intraoperative three-dimensional CT scanning surgical room for 118 patients with spinal disorders (upper cervical deformity 2 cases, sacral cyst 1 case, 4 cases of discoscopy, 10 cases of spinal biopsy, 10 cases of cervical spine degeneration (anterior 2 cases, posterior 7 cases, cervical disc replacement 1 case of the company of the AO), 7 cases of kyphotic deformity, 13 cases of spinal tumors, 20 cases of scoliotic deformity, 29 cases of lumbar degeneration, thoracic spine degeneration 2 cases, spinal fracture 18 cases, other interoperative patients immediate postoperative review 2 cases). CT scan alone was used in 93 patients. CT scan and integrated navigation system were used together in 25 patients (cervical degeneration posteriorly in 2 cases, kyphosis deformity in 1 case, spinal tumors in 7 cases (3 of which were minimally invasive internal fixation with the Sextant system), scoliotic deformity in 8 cases, lumbar degeneration in 5 cases (for minimally invasive internal fixation with the Sextant system), and spinal fractures in 2 cases). A total of 833 pedicle screws were implanted, including 144 in the cervical spine, 379 in the thoracic spine, and 310 in the lumbar spine. A total of 232 pedicle screws were implanted under navigation, including 46 in the cervical spine, 112 in the thoracic spine, and 76 in the lumbar spine. The excellent rate of screws implanted under navigation was significantly higher than that of the freehand implantation group (P<0.05). The preliminary application confirms the strong feasibility of this system in spinal surgery. After the personnel at each position mastered the work procedures, the average time of each surgical interruption caused by CT scanning alone and CT scanning together with the integrated navigation system could be controlled within 10 and 14 minutes, respectively. The image quality of intraoperative 3D CT scanning is excellent, which can fully meet the surgical needs of any part of spine surgery. CONCLUSION: The system can be installed in any prefabricated surgical suite without the need for special additional surgical facilities. It increases the safety of the patient and the spine surgeon without changing the current spine surgery program and workflow. CT scans and navigation data can be updated at any time according to the surgical plan and the accuracy of the navigation, which is highly accurate and time-consuming. It can also be widely used in other areas of orthopedics and other departments.