Hott Jonathan S, Papadopoulos Stephen M, Theodore Nicholas, Dickman Curtis A, Sonntag Volker K H
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
Spine (Phila Pa 1976). 2004 Dec 15;29(24):2856-60. doi: 10.1097/01.brs.0000147742.20637.49.
Fifty-two study participants underwent cervical spine surgery using intraoperative Iso-C imaging with or without spinal navigation.
To evaluate prospectively the feasibility, advantages, limitations, and applications of Iso-C in cervical spine surgery.
Existing stereotactic spinal navigational systems images must be acquired before surgery and typically require cumbersome point-to-point registration. Intraoperative computed tomography (CT) and magnetic resonance imaging (MRI) provide real-time information but can restrict access to the patient, preclude the use of traditional operating room tables, and are time-consuming. The Iso-C allows quick, CT-quality, real-time data acquisition without restricting access to the patient. The data acquired can be automatically transferred to navigational systems with the immediate ability to navigate for anterior or posterior cervical spine procedures.
High-resolution isotropic three-dimensional data sets were acquired using the Iso-C intraoperative fluoroscopy in 52 cervical spine cases. In 30 cases, the data were imported automatically to the StealthStation Treon to support neuronavigation. In 22 cases, a postprocedural intraoperative CT was obtained with the Iso-C primarily to assess the extent of osseous decompression and/or the accuracy of implants or instrumentation. In most cases, a postoperative high-resolution CT image was obtained and compared with the Iso-C data.
Successful automated registration suitable for navigation was attained for all anterior and posterior cervical spinal cases. The postprocedural intraoperative Iso-C data were 100% concordant with those of postoperative high-resolution CT as determined by a blinded neuroradiologist.
Iso-C intraoperative fluoroscopy is an accurate and rapid way to perform CT-quality image-guided navigation in cervical spinal surgery. In most cases, it obviates the need for postoperative imaging.
52名研究参与者接受了使用术中Iso-C成像技术（有无脊柱导航）的颈椎手术。
前瞻性评估Iso-C在颈椎手术中的可行性、优势、局限性及应用情况。
现有的立体定向脊柱导航系统图像必须在手术前获取，且通常需要繁琐的点对点配准。术中计算机断层扫描（CT）和磁共振成像（MRI）可提供实时信息，但会限制对患者的操作，无法使用传统手术台，且耗时较长。Iso-C可在不限制对患者操作的情况下快速获取CT质量的实时数据。所获取的数据可自动传输至导航系统，能够立即用于颈椎前路或后路手术的导航。
在52例颈椎病例中，使用Iso-C术中透视获取高分辨率各向同性三维数据集。30例中，数据自动导入StealthStation Treon以支持神经导航。22例中，主要使用Iso-C获取术后术中CT，以评估骨减压程度和/或植入物或器械的准确性。大多数情况下，获取术后高分辨率CT图像并与Iso-C数据进行比较。
所有颈椎前路和后路病例均成功实现了适用于导航的自动配准。经一名不知情的神经放射科医生判定，术后术中Iso-C数据与术后高分辨率CT数据100%一致。
Iso-C术中透视是颈椎手术中进行CT质量图像引导导航的准确且快速的方法。在大多数情况下，无需术后成像。
