Fuster S, Vega A, Barrios G, Urdaneta I, Ojeda O, Macchia M, Combalia A, Berenguer J, Pujol T
Unitat de Raquis, Hospital Clínic, Universitat de Barcelona, España.
Neurocirugia (Astur). 2010 Aug;21(4):306-11. doi: 10.4321/s1130-14732010000400003.
Computer image guidance is one of the most significant technologic advancements in the spine surgery, because preoperative or intraoperative images can be used for multiplanar, three-dimensional intraoperative navigation.
We performed a prospective clinical study to assess the accuracy of pedicle screw insertion using an optoelectronic navigation system (SurgiGATE Spine 2.1 Medivision). The study population included 29 patients with diverse disorders of the thoraco- lumbar spine (degenerative 54%, spondylolisthesis 21%, fractures 14%, scoliosis 7% and spondylodiscitis 4%). One patient was excluded from the study because problems with the specific instruments or the computer system. Pre and post-operative axial computed tomography images were obtained for each patient and analyzed by two independent radiologists to placement accuracy. The correct location was defined accord to Heary scale in 5 grades.
163 image-guided thoraco-lumbar pedicle screws were placed 29 in the thoracolumbar spine and 134 in the lumbosacral spine. We achieved a completely intraosseous placement (Grade I) in 99.4% of lumbosacral spine screws and 100% of thoracolumbar spine screws. Only one misplaced screw (Grade III) in the pedicle of L III in the concavity of a scoliosis was reported. No implant related complications were noted.
The low rate of misplaced screws in this prospective study compares favorably with previously published results. Our initial results indicate that Image-guided spinal surgery is a safe technique which improves surgical performance during posterior transpedicle stabilization.
计算机图像引导是脊柱外科最重要的技术进步之一，因为术前或术中图像可用于多平面、三维术中导航。
我们进行了一项前瞻性临床研究，以评估使用光电导航系统（SurgiGATE Spine 2.1 Medivision）置入椎弓根螺钉的准确性。研究人群包括29例患有各种胸腰椎疾病的患者（退行性疾病占54%，椎体滑脱占21%，骨折占14%，脊柱侧弯占7%，脊椎椎间盘炎占4%）。一名患者因特定器械或计算机系统问题被排除在研究之外。为每位患者获取术前和术后轴向计算机断层扫描图像，并由两名独立的放射科医生分析置入准确性。根据Heary分级标准将正确位置分为5级。
共置入163枚图像引导下的胸腰椎椎弓根螺钉，其中29枚位于胸腰椎，134枚位于腰骶椎。我们在99.4%的腰骶椎螺钉和100%的胸腰椎螺钉中实现了完全骨内置入（I级）。仅报告了1枚位于脊柱侧弯凹侧L III椎弓根的置错螺钉（III级）。未发现与植入物相关的并发症。
这项前瞻性研究中置错螺钉的发生率较低，与之前发表的结果相比具有优势。我们的初步结果表明，图像引导下的脊柱手术是一种安全的技术，可在经椎弓根后路稳定手术中提高手术效果。
