Department of Neurosurgery, Montefiore Medical Center, Bronx, New York 10467, USA.
Neurosurgery. 2012 Apr;70(4):990-5. doi: 10.1227/NEU.0b013e318237a829.
Increasing popularity of minimally invasive surgery for lumbar fusion has led to dependence upon intraoperative fluoroscopy for pedicle screw placement, because limited muscle dissection does not expose the bony anatomy necessary for traditional, freehand techniques nor for registration steps in image-guidance techniques. This has raised concerns about cumulative radiation exposure for both surgeon and operating room staff. The recent introduction of the O-arm Multidimensional Surgical Imaging System allows for percutaneous placement of pedicle screws, but there is limited clinical experience with the technique and data examining its accuracy.
We present the first large clinical series of percutaneous screw placement using navigation of O-arm imaging and compare the results with the fluoroscopy-guided method.
A retrospective review of a 24-month period identified patients undergoing minimally invasive lumbar interbody fusion. The O-arm was introduced in the middle of this period and was used for all subsequent patients. Accuracy of screw placement was assessed by examination of axial computed tomography or O-arm scans.
The fluoroscopy group included 141 screws in 42 patients, and the O-arm group included 205 screws in 52 patients. The perforation rate was 12.8% in the fluoroscopy group and 3% in the O-arm group (P < .001). Single-level O-arm procedures took a mean 200 (153-241) minutes, whereas fluoroscopy took 221 (178-302) minutes (P < .03).
Percutaneous pedicle screw placement with the O-arm Multidimensional Intraoperative Imaging System is a safe and effective technique and provided improved overall accuracy and reduced operative time compared with conventional fluoroscopic techniques.
微创腰椎融合术的日益普及使得经皮椎弓根螺钉置入术依赖术中透视，因为有限的肌肉解剖不能暴露传统徒手技术所需的骨性解剖结构，也不能暴露影像引导技术的注册步骤。这引起了人们对术者和手术室工作人员累积辐射暴露的关注。最近推出的 O 臂多维手术成像系统允许经皮椎弓根螺钉置入，但该技术的临床经验有限，且缺乏关于其准确性的数据。
我们报告了首次使用 O 臂影像导航进行经皮螺钉置入的大型临床系列研究，并将结果与透视引导方法进行比较。
回顾性分析了 24 个月内接受微创腰椎椎间融合术的患者。O 臂在这期间的中期引入，并用于所有后续患者。通过轴向计算机断层扫描或 O 臂扫描检查评估螺钉放置的准确性。
透视组包括 42 例患者的 141 枚螺钉，O 臂组包括 52 例患者的 205 枚螺钉。透视组的穿孔率为 12.8%，O 臂组为 3%（P<0.001）。单节段 O 臂手术平均用时 200 分钟（153-241 分钟），而透视组用时 221 分钟（178-302 分钟）（P<0.03）。
与传统透视技术相比，O 臂多维术中成像系统的经皮椎弓根螺钉置入术是一种安全有效的技术，可提高整体准确性并缩短手术时间。
