PMC8678078_01
Case 1: aggressive osteoblastoma in C3/C4. (a-c) CT scan reconstructions of the cervical spine with a left-sided osteolysis in C3 and C4. (d, e) MRI shows the extent of the tumor and its close relation to the vertebral artery. (f) En bloc resected tumor. (g, h) Postoperative a.p. and lateral radiographs after resection of the tumor and combined posteroanterior stabilization. (i, j) CT scan 3-D reconstructions show the osseous defect after tumor resection.
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Radiographs, CT scan, and MRI revealed a tumor at the left side C3-C4 in the cervical spine (Figure 1) without further pathologies in the complete tumor workup (PET-CT, laboratory tests).
PMC8678078_02
Case 2: aggressive osteoblastoma in C3. (a-d) CT scan reconstructions of the cervical spine with a right-sided lesion in C3. (e) MRI shows the soft-tissue component of the tumor. (f, g) Postoperative a.p. and lateral radiographs after resection of the tumor and combined posteroanterior stabilization.
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The radiographs, CT scan, and MRI revealed a tumor of C3 at the right side of the cervical spine (Figure 2).
Drill guide templates. (a) Exemplary virtual presentation of the template provided by the manufacturer. This allows for meticulous planning of the entry point and the different screw parameters. (b) Shows the possibility to test the fit between the drill guide and the corresponding vertebra ex situ.
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On a standardized platform provided by the company, a template with these proposals for the screw parameters is available for the surgeon (Figure 3(a)). During surgery, the sterile device can be used to get a better feeling for the proper placement of the template (Figure 3(b)).
Precision of screw positioning. Axial reconstructions of the postoperative CT scan (case 2) to evaluate the correct placement of the pedicle screws. In both examples, the correct position of the screws could be confirmed.
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Postoperative screw position was evaluated by a routinely postoperative performed CT scan (Figure 4).
Follow-up. (a, b) a.p. and lateral radiographs of the cervical spine of case 1 at 12 months postoperatively. (c, d) a.p. and lateral radiographs of the cervical spine of case 2 at 4 months postoperatively.
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There was no neurological deficit, and imaging (radiographs and MRI) showed neither implant loosening nor local recurrence (Figures 5(a) and 5(b)). The radiographs at follow-up revealed unchanged and unremarkable findings (Figures 5(c) and 5(d)).