Wang Yu, Le Dang Q S, Li Haisheng, Wang Miao, Eric Bünger Cody
Department of Orthopaedics E, Aarhus University Hospital, Aarhus, Denmark.
Comput Aided Surg. 2011;16(3):135-42. doi: 10.3109/10929088.2011.559412. Epub 2011 Mar 7.
Advances in surgical navigation have opened new possibilities for lumbosacral interbody fusion procedures. We have designed a novel navigated surgical method, Navigated Percutaneous Lumbosacral Interbody Fusion (NPLSIF), that enables lumbosacral discectomy and bone grafting to be performed percutaneously and safely.
To prove that NPLSIF is feasible from an anatomical perspective, it was simulated on 3D models of the lumbosacral spine created using CT data from 60 patients. Feasibility would be verified if both the working corridor and the S1 pedicle screw could be accommodated in the sacral ala without overlapping and without penetrating either the spinal canal or the anterior or upper sacral wall. In addition, the discectomy that could be achieved using NPLSIF was evaluated, and a surgical experiment was performed using a plastic torso model.
The 3D modeling and surgical simulation were successfully completed in all cases. The feasibility of the NPLSIF approach was verified in every case, i.e., both the working corridor and the S1 pedicle screw were accommodated in the sacral ala without overlapping and without penetrating either the spinal canal or the anterior or upper sacral wall. The mean ratio of the area of discectomy that could be achieved by NPLSIF to the total area of the lumbosacral disc was 0.721 ± 0.065 (range: 0.57-0.894), 0.956 ± 0.045 (range: 0.8-1.0) and 0.945 ± 0.058 (range: 0.813-1.0) in the axial, coronal and sagittal planes, respectively. NPLSIF was also successfully executed on the plastic torso model. Preoperative planning on the navigation workstation took 5 minutes and each intraoperative CT scan took 30 seconds. Locating the entry point of the working corridor according to the preoperative plan took 3 minutes. Postoperative CT images and direct viewing of the plastic model revealed no penetration of the spinal canal or sacral wall.
The feasibility of Navigated Percutaneous Lumbosacral Interbody Fusion (NPLSIF) was verified from an anatomical perspective. We also demonstrated that an adequate discectomy can be achieved using the procedure. Cadaveric experiments and clinical trials are needed to further evaluate the efficacy and efficiency of NPLSIF.
手术导航技术的进步为腰骶椎间融合手术开辟了新的可能性。我们设计了一种新型的导航手术方法，即导航经皮腰骶椎间融合术（NPLSIF），该方法能够经皮安全地进行腰骶椎间盘切除术和植骨术。
为了从解剖学角度证明NPLSIF是可行的，我们在使用60例患者的CT数据创建的腰骶椎三维模型上进行了模拟。如果工作通道和S1椎弓根螺钉能够容纳在骶骨翼内，且不重叠，不穿透椎管或骶骨前壁或上壁，则证明该方法可行。此外，我们评估了使用NPLSIF能够实现的椎间盘切除范围，并使用塑料人体模型进行了手术实验。
所有病例均成功完成三维建模和手术模拟。在每个病例中均验证了NPLSIF方法的可行性，即工作通道和S1椎弓根螺钉均能容纳在骶骨翼内，且不重叠，不穿透椎管或骶骨前壁或上壁。NPLSIF在轴位、冠状位和矢状位上能够实现的椎间盘切除面积与腰骶椎间盘总面积的平均比值分别为0.721±0.065（范围：0.57 - 0.894）、0.956±0.045（范围：0.8 - 1.0）和0.945±0.058（范围：0.813 - 1.0）。NPLSIF在塑料人体模型上也成功实施。在导航工作站上进行术前规划耗时5分钟，每次术中CT扫描耗时30秒。根据术前规划确定工作通道的入口点耗时3分钟。术后CT图像和对塑料模型的直接观察显示椎管或骶骨壁未被穿透。
从解剖学角度验证了导航经皮腰骶椎间融合术（NPLSIF）的可行性。我们还证明了使用该手术方法能够实现充分的椎间盘切除。需要进行尸体实验和临床试验以进一步评估NPLSIF的疗效和效率。
