Institute of Orthopedics, General Hospital of PLA, Beijing, China.
Spine (Phila Pa 1976). 2012 May 1;37(10):891-900. doi: 10.1097/BRS.0b013e31823aff81.
A retrospective analysis of patients undergoing spinal deformity correction surgery by the assistance of intraoperative computed tomography (iCT) with or without navigation system.
To share our preliminary experience and analysis of the iCT navigation system applied to spinal deformity surgery.
The iCT navigation system has been shown to improve accuracy and safety in posterior instrumentation. It not only decreased the operation time but also prevented excessive radiation exposure to the medical staff. To date, there are only few reports about the application of the iCT navigation system in spinal deformity surgery.
From April 2009 to September 2010, 59 patients who had a diagnosis of scoliosis, kyphosis, or scoliokyphosis and underwent iCT-assisted surgical correction were included. Without randomization, 28 patients were operated with the iCT-navigation system, and the other 31 patients were operated with standard procedure under iCT assistance. The detailed procedures, preoperative and intraoperative images were illustrated. The accuracy of screw placement, time for screw insertion, postoperative correction rate, and iCT scanning data were analyzed.
There were significant differences between 2 groups in (1) the preoperative Cobb angle (76.2° and 62.6° in the navigation and non-navigation groups), (2) the accuracy and the revision rate of thoracic pedicle screws and total pedicle screws, and (3) the average screw insertion time. The breach rate and the revision rate of thoracic pedicle screws and total pedicle screws were significantly lower and the average screw insertion time was significantly lesser in the navigation group than in the non-navigation group. There were no statistically significant difference in (1) the breach rate and the revision rate of lumbar pedicle screws, (2) the mean iCT scanning time and time-out, (3) the mean number of fusion segments, (4) the mean number of iCT scans, and (5) the postoperative correction rate. Complications were encountered in 2 patients in the non-navigation group but none in the navigation group. There was no reoperation due to implant malposition in both groups.
The iCT navigation system provides desirable accuracy of posterior spinal instrumentation for patients during surgical correction of spinal deformity without radiation exposure to the medical staff, especially in thoracic spine instrumentation. Meanwhile, the iCT in itself is an effective means of assessing complex instrumentation of the spinal deformity.
回顾性分析术中计算机断层扫描（iCT）辅助下脊柱畸形矫正手术的患者，其中包括使用或不使用导航系统的患者。
分享我们在脊柱畸形手术中应用 iCT 导航系统的初步经验和分析。
iCT 导航系统已被证明可提高后路器械的准确性和安全性。它不仅缩短了手术时间，还防止了医护人员过度暴露于辐射下。迄今为止，仅有少数关于 iCT 导航系统在脊柱畸形手术中应用的报道。
从 2009 年 4 月至 2010 年 9 月，共纳入 59 例诊断为脊柱侧凸、后凸或脊柱后凸侧凸并接受 iCT 辅助手术矫正的患者。我们未进行随机分组，其中 28 例患者使用 iCT 导航系统进行手术，而其余 31 例患者则在 iCT 辅助下采用标准手术程序进行手术。详细介绍了手术过程、术前和术中图像。分析了螺钉置入的准确性、螺钉置入时间、术后矫正率和 iCT 扫描数据。
两组患者在以下方面存在显著差异：（1）术前 Cobb 角（导航组和非导航组分别为 76.2°和 62.6°），（2）胸椎和全椎弓根螺钉的准确性和修正率，以及（3）平均螺钉插入时间。导航组的螺钉置入准确率更高，螺钉修正率更低，平均螺钉插入时间更短。两组患者在以下方面无统计学差异：（1）腰椎椎弓根螺钉的穿孔率和修正率，（2）平均 iCT 扫描时间和超时时间，（3）平均融合节段数，（4）平均 iCT 扫描次数，以及（5）术后矫正率。非导航组有 2 例患者发生并发症，而导航组无并发症。两组均无因植入物位置不当而再次手术的病例。
iCT 导航系统为脊柱畸形矫正手术中的患者提供了理想的后路脊柱器械准确性，同时避免了医护人员的辐射暴露，尤其是在胸椎脊柱器械方面。同时，iCT 本身是评估脊柱畸形复杂器械的有效手段。
