Department of Spine and Orthopaedic Surgery, Konan Kosei Hospital, Konan City, Japan.
J Neurosurg Spine. 2010 Nov;13(5):606-11. doi: 10.3171/2010.5.SPINE09993.
The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN).
The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT.
The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16-6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26-12.02) in Grade 3 perforations.
Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.
作者进行了一项回顾性临床研究，以评估基于三维荧光透视导航（3D FN）的颈椎椎弓根螺钉（CPS）置入的可行性和准确性。
这项研究纳入了 2003 年至 2008 年间接受颈椎后路稳定治疗的 62 例连续患者。30 例患者（126 枚螺钉）采用传统技术（CVT），即侧位荧光透视，而 32 例患者（150 枚螺钉）采用 3D FN。根据术后 CT 观察到的椎弓根壁穿孔情况，螺钉位置分为 4 个等级。
CVT 组的穿孔发生率为 27%（34 枚螺钉）：0 级（无穿孔）为 92 枚（73.0%），1 级（穿孔<1mm）为 12 枚（9.5%），2 级（穿孔≥1mm 且<2mm）为 6 枚（4.8%），3 级（穿孔≥2mm）为 16 枚（12.7%）。3D FN 组的穿孔发生率为 18.7%（28 枚螺钉）：0 级（无穿孔）为 122 枚（81.3%），1 级（穿孔<1mm）为 17 枚（11.3%），2 级（穿孔≥1mm 且<2mm）为 6 枚（4%），3 级（穿孔≥2mm）为 5 枚（3.3%）。统计学分析显示，CVT 和 3D FN 组 1 级或更高穿孔的发生率无显著差异。3D FN 组 2 级或更高（17.5%比 7.3%，p<0.05）和 CVT 组 3 级（12.7%比 7.3%，p<0.05）穿孔的 CPS 错位发生率更高。CVT 组 2 级或更高穿孔的 CPS 错位的 OR 为 2.72（95%CI 1.16-6.39），3 级穿孔的 OR 为 3.89（95%CI 1.26-12.02）。
基于三维荧光透视的导航技术可以提高 CPS 插入的准确性；然而，即使使用 3D FN，也会发生严重的 CPS 错位，导致椎动脉损伤或神经并发症。先进的 CPS 插入技术和改良的插入装置的使用可以降低 CPS 错位的风险，提供更高的安全性。
