Accuracy and Feasibility of Intraoperative Computed Tomography Navigation with a Clavicular Reference Frame in Anterior Cervical Spine Surgery: A Preliminary Report

Abstract

Introduction: The application of intraoperative computed tomography (CT) navigation in anterior cervical spine surgery remains limited because of challenges in securing a stable reference frame during supine positioning and the absence of reliable bony landmarks in the anterior cervical region. To overcome these limitations, we propose a novel technique involving reference frame placement on the proximal diaphysis of the clavicle and evaluate its feasibility and navigation accuracy. Technical Note: Five patients (4 males, 1 female; mean age 59±15 years) underwent anterior cervical surgery for cervical ossification of the posterior longitudinal ligament (n=2), cervical disc herniation (n=2), and cervical spondylotic amyotrophy (n=1). The reference frame was affixed to the clavicle contralateral to the operating surgeon. Intraoperative CT scans were obtained using a robotic C-arm angiography system and navigation was performed via an optical surgical navigation system. Navigation accuracy was assessed in 3 planes: mediolateral (x), craniocaudal (y), and anteroposterior (z). Navigation errors (mean±standard deviation) were 0.29±0.24 mm (x), 0.47±0.31 mm (y), and 0.64±0.59 mm (z), all within clinically acceptable limits. No intraoperative or postoperative complications, including clavicle fracture, subclavian vessel injury, or supraclavicular nerve damage, were observed. Compared with previously reported techniques, this method demonstrated favorable accuracy. Conclusions: Clavicle-based reference frame placement offers high navigation accuracy and technical feasibility in anterior cervical spine surgery. Larger studies are warranted to confirm its clinical utility and safety.