T1 Vertebra Pedicular Osteoid Osteoma: Minimally Invasive Surgical Resection Aided by New Integrated Navigation to 3D Imaging Device

Abstract

We hereby describe a minimally invasive resection of a T1 pedicular osteoid osteoma next to the vertebral canal. The patient had an 18-month report of painful radiculopathy. We performed the surgery under 3D imaging guidance using navigation with an all-in-one device. Full procedure irradiation was 1.17 mSv for a 181-picture acquisition. Complete operative time incision to closure was 58 minutes. Despite sparing the vertebral stability without any fixation, the tumor resection was well-margined, thanks to the focused guidance. After surgery, the patient had complete relief of his symptoms at the 6-month follow-up. 3D imaging system coupled to navigation made the procedure safe without consuming time. The single Surgivisio® device allows comfortable 3D minimally invasive spine navigation surgery with the ergonomics of a C-arm.

Figures

Figure 1

CT scan and MRI of the spine and bone scan. The CT scan shows a rounded osteolytic lesion surrounded by sclerotic bone. Its size is inferior to 15 mm of diameter, within a nidus. MRI shows a T2 hypersignal and a T1 hyposignal on the right side of the T1 vertebra, until the vertebral body with an attachment to the pedicle, and an inflammation of the right T1 root. The bone scan shows hyperfixation of the right T1 vertebra region.

Figure 2

Patient reference in Surgivisio®. The reference frame is fixed to the patient using 2 to 4 pins introduced into spinous processes. We can first put an imaging reference frame (a), then another reference frame for the navigation (b).

Figure 3

Intraoperative aspect. Navigation imaging (a). We can notice the nidus aspect close to the navigated trocar. The blue landmarks are separated 1 cm each. Reference frame and navigation trocar (b). Mini-open access, with the partial right laminectomy of the T1 vertebra (c) less than 1 cm square-sized. We can notice the pin inside the spinous process of the T1 vertebra.

Figure 4

Postoperative spine CT scan after one week. The images confirmed the complete resection of the lesion, without destabilizing the vertebral column.

Figure 5

Histopathological examination (standard coloration). An area of hypovascular sclerotic bone surrounding the tumor is seen at low (×100) magnification (a, left part). The intertrabecular space is filled with fibrovascular stroma (a, right part). The central portion of the lesion (nidus) is characterized by differentiating osteoblasts engaged in the production of osteoid tissue. Absence of mitoses and necrosis. (b) ×400 magnification.