Rauschmann Michael A, Thalgott John, Fogarty Madilyne, Nichlos Manos, Kleinszig Gerhard, Knap Mariusz, Kafchitsas Konstantinos
Department of Orthopaedic Surgery, Johann Wolfgang Goethe University in Frankfurt am Main, Frankfurt am Main, Germany.
Spine (Phila Pa 1976). 2009 May 1;34(10):1110-5. doi: 10.1097/BRS.0b013e31819e2235.
Comparison of total disc replacement (TDR) with and without computer-assisted surgical navigation.
To test and evaluate the accuracy of computer-assisted navigation for the lumbar spine by comparing the traditional C-arm-aided insertion of an arthroplasty device to the navigation-aided insertion of the implant.
Previous studies have shown that poor placement of the CHARITE disc can be correlated to worse clinical results. Because of parallax effect, exclusive use of fluoroscopy could make placement of the artificial disc less accurate. False positioning may also lead to spondylolisthesis, disc degeneration of the adjacent segment, subsidence of the disc, and failure of the implant.
Ten human cadaver spine specimens were used at 3 lumbar segments (L3-L4, L4-L5, and L5-S1). Before implantation, all artificial discs were planned for "ideal" placement on a digital computed tomography image. Fifteen lumbar intervertebral disc prostheses (Depuy, Raynham, MA) were placed using Vector Vision image guidance (BrainLAB AG, Munich, Germany), by an inexperienced TDR-surgeon. Fifteen lumbar intervertebral disc prostheses were placed with exclusive use of fluoroscopy by an experienced TDR-surgeon. After insertion, DICOM computed tomography scans were analyzed using computer software to assess placement accuracy of each disc prosthesis.
The navigated placement of the disc was significantly more accurate. Only 3 navigated disc prostheses were suboptimal and none was poorly placed.
Surgical computer-assisted navigation may be a useful tool in the hands of a spine surgeon to achieve more accurate placement of the disc prosthesis. Because of the parallax effect, computer-assisted navigation offers more placement accuracy than stan- dard fluoroscopy. Because the accurate placement of total disc prosthesis has been correlated with better clinical outcome, further study regarding the navigation of the TDR is essential.
有计算机辅助手术导航与无计算机辅助手术导航的全椎间盘置换术（TDR）对比研究。
通过比较传统C形臂辅助下人工关节置换装置的植入与导航辅助下植入物的植入，测试和评估腰椎计算机辅助导航的准确性。
先前的研究表明，CHARITE椎间盘放置不佳可能与较差的临床结果相关。由于视差效应，单纯使用荧光透视法可能会使人工椎间盘的放置不够准确。错误定位还可能导致椎体滑脱、相邻节段椎间盘退变、椎间盘下沉以及植入物失效。
使用10个人类尸体腰椎标本，节段为L3 - L4、L4 - L5和L5 - S1。植入前，所有人工椎间盘均在数字计算机断层扫描图像上规划“理想”放置位置。由一位经验不足的TDR外科医生使用Vector Vision图像引导系统（德国慕尼黑BrainLAB AG公司）植入15个腰椎间盘假体（美国马萨诸塞州雷纳姆市Depuy公司生产）。由一位经验丰富的TDR外科医生单纯使用荧光透视法植入15个腰椎间盘假体。植入后，使用计算机软件分析DICOM计算机断层扫描，以评估每个椎间盘假体的放置准确性。
导航辅助下的椎间盘放置明显更准确。只有3个导航辅助下的椎间盘假体放置欠佳，没有放置很差的。
手术计算机辅助导航对于脊柱外科医生而言可能是一种有用的工具，可实现椎间盘假体更准确的放置。由于视差效应，计算机辅助导航比标准荧光透视法提供更高的放置准确性。由于全椎间盘假体的准确放置与更好的临床结果相关，因此关于TDR导航的进一步研究至关重要。
