Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl). 2010 Nov;123(21):2995-8.
The complicated anatomy of the cervical spine and the variation among pedicles reduces the accuracy and increases the risk of neurovascular complications associated with screw implantation in this region. In this study, we compared the accuracy of cervical (C2-C7) pedicle screw fixation assisted by X-ray fluoroscopy, computed tomography (CT)-based navigation, or intraoperative three-dimensional (3D) C-arm navigation.
This prospective cohort study was performed in 82 consecutive patients who underwent cervical pedicle screw fixation. The accuracy of screw insertion was assessed by postoperative CT scan with 3D reconstruction. The accuracy of screw insertion was assessed as: excellent (screw completely within pedicle); acceptable (≤ 1 mm screw outside pedicle cortex); poor (> 1 mm screw outside pedicle cortex).
A total of 145 screws were inserted in 24 patients who underwent C-arm fluoroscopy. Of these, 96 screws (66.2%) were excellent, 37 (25.5%) were acceptable, and 12 (8.3%) were poor. One hundred and fifty-nine screws were inserted in 29 patients in the CT-based navigation group. Among these, 141 (88.7%) were excellent, 14 (8.8%) were acceptable, and 4 (2.5%) were poor. A total of 140 screws were inserted in 29 patients in the intraoperative 3D C-arm navigation group, of which 127 (90.7%) were excellent, and 13 (9.3%) were acceptable. No severe or permanent neurovascular complications associated with screw insertion were observed in any patient.
CT-based and intraoperative 3D C-arm navigation were similarly accurate, and were both significantly more accurate than C-arm fluoroscopy for guiding cervical pedicle screw fixation. They were able to accurately guide the angle and depth of screw placement using visual 3D images. These two techniques are therefore preferable for high-risk cervical pedicle screw fixation. The ease and convenience of intraoperative 3D C-arm navigation suggests that it may replace virtual-fluoroscopy and CT-based navigation systems in future clinical applications.
颈椎的复杂解剖结构和椎弓根的变异降低了该区域螺钉植入的准确性，并增加了与神经血管并发症相关的风险。在本研究中，我们比较了 X 射线透视、基于计算机断层扫描（CT）的导航或术中三维（3D）C 臂导航辅助下颈椎（C2-C7）椎弓根螺钉固定的准确性。
这是一项前瞻性队列研究，共纳入 82 例连续接受颈椎椎弓根螺钉固定的患者。术后通过三维 CT 重建评估螺钉置入的准确性。螺钉置入的准确性评估为：优（螺钉完全位于椎弓根内）；可接受（≤1mm 螺钉位于椎弓根皮质外）；差（>1mm 螺钉位于椎弓根皮质外）。
24 例患者接受 C 臂透视下共置入 145 枚螺钉，其中优 96 枚（66.2%），可接受 37 枚（25.5%），差 12 枚（8.3%）。29 例患者在基于 CT 的导航组中共置入 159 枚螺钉，其中优 141 枚（88.7%），可接受 14 枚（8.8%），差 4 枚（2.5%）。29 例患者在术中 3D C 臂导航组中共置入 140 枚螺钉，其中优 127 枚（90.7%），可接受 13 枚（9.3%）。在任何患者中均未观察到与螺钉置入相关的严重或永久性神经血管并发症。
基于 CT 和术中 3D C 臂导航同样准确，与 C 臂透视相比，均显著提高了颈椎椎弓根螺钉固定的准确性。它们能够使用直观的三维图像准确引导螺钉的角度和深度。因此，这两种技术对于高危颈椎椎弓根螺钉固定更为理想。术中 3D C 臂导航的简便性提示其可能在未来的临床应用中替代虚拟透视和基于 CT 的导航系统。
