Sasso Rick C, Garrido Ben J
Clinical Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46260, USA.
J Spinal Disord Tech. 2007 Apr;20(2):118-22. doi: 10.1097/01.bsd.0000211263.13250.b1.
To review the operative time differences between computer-assisted spinal navigation versus serial radiography.
There have been multiple studies describing the use of computer-assisted image guided surgery (IGS) in the application of spinal instrumentation. Techniques have evolved to allow attainment of multilevel visualization intraoperatively both successfully and safely. These have proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing. As a result, image guidance has become an increasingly accepted and practiced form of intraoperative spinal navigation. However, potential limitations to IGS have been described including longer operating times. Many studies have looked at the success of beneficial outcomes; however, none to our knowledge have reviewed such described operative time increments with IGS.
The authors performed a retrospective database analysis of 105 patients undergoing posterior L5-S1 spine fusion with pedicle screw instrumentation for isthmic spondylolisthesis with and without the use of fluoroscopy-based image guidance. This was followed by a chart review of anesthesia operative time documentation. Subsequent time calculations and statistical analysis were performed for comparison.
Computer-assisted image-guided spine surgery has overall demonstrated shorter mean operative times when compared with intraoperative serial radiography technique; an average of 40 minutes less per case (P<0.001). There is also less variation in operative times using image guidance, with 13 of 43 (30%) cases using serial x-ray lasting more than 3.75 hours compared with none of the 57 done via image guidance (P<0.001). The operative duration for both procedures trended downward over time. For both procedural cohorts operating room time continued to decrease as of the most recent year being performed. Lastly, in an attempt to minimize such a confounding factor as a learning curve, the last 20 cases in each group were compared. There was an average difference of about 22 minutes less for the image guidance group but missed being statistically significant (P=0.0503).
Image-guided spinal surgery did not cause an increase in operative time. In the best scenario, image navigation saved a statistically significant (P<0.001) amount of time in the operating room. At its worst, fluoroscopy-based image-guided navigation is not significantly different from standard serial radiography.
回顾计算机辅助脊柱导航与系列X线摄影在手术时间上的差异。
已有多项研究描述了计算机辅助影像引导手术（IGS）在脊柱内固定应用中的情况。技术不断发展，已能在术中成功且安全地实现多节段可视化。这些技术已被证明可降低螺钉误置率、减少辐射暴露发生率并提供极佳的术野视野。因此，影像引导已成为术中脊柱导航越来越被接受和应用的形式。然而，IGS的潜在局限性也已被描述，包括手术时间延长。许多研究关注了有益结果的成功率；然而，据我们所知，尚无研究对IGS所描述的手术时间增加情况进行回顾。
作者对105例行后路L5 - S1脊柱融合并使用椎弓根螺钉内固定治疗峡部裂性腰椎滑脱症的患者进行了回顾性数据库分析，这些患者使用或未使用基于荧光透视的影像引导。随后对麻醉手术时间记录进行图表审查。进行后续时间计算和统计分析以作比较。
与术中系列X线摄影技术相比，计算机辅助影像引导脊柱手术总体上显示出平均手术时间更短；每例平均少40分钟（P < 0.001）。使用影像引导时手术时间的变化也更小，43例使用系列X线的病例中有13例（30%）手术持续时间超过3.75小时，而通过影像引导完成的57例中无一例如此（P < 0.001）。两种手术的手术持续时间均随时间呈下降趋势。对于两个手术队列，截至最近一年进行手术时，手术室时间持续减少。最后，为尽量减少学习曲线等混杂因素的影响，对每组最后20例病例进行了比较。影像引导组平均少约22分钟，但未达到统计学显著性（P = 0.0503）。
影像引导脊柱手术并未导致手术时间增加。在最佳情况下，影像导航在手术室节省了具有统计学显著性（P < 0.001）的时间。在最不利的情况下，基于荧光透视的影像引导导航与标准系列X线摄影无显著差异。
