Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
J Clin Neurosci. 2012 Aug;19(8):1137-43. doi: 10.1016/j.jocn.2012.01.020. Epub 2012 Jun 20.
The purpose of this ambispective cohort study is to describe the emerging role of intra-operative cone-beam CT (O-arm®, Medtronic, Minneapolis, MN, USA), frequently coupled with stereotactic navigation (StealthStation®, Medtronic), in the surgical management of acute spinal trauma. All patients with acute spinal trauma between May 2009 and May 2011 who were treated with the use of the O-arm were identified from a prospectively collected spine database and retrospectively analyzed to characterize indications and outcomes. Over the two-year period, the O-arm was used in 183 spinal operations; 27 of these (15%) involved acute spinal trauma. Within the trauma cohort, 14 injuries were in the cervical spine, nine at the cervicothoracic junction, and four were in the thoracolumbar spine. In 12 patients (44%) pre-existing aberrant and challenging anatomy, commonly ankylosing conditions, were present. Surgical techniques included transarticular atlantoaxial fixation and direct osteosynthesis of a Hangman's fracture performed entirely percutaneously (via two stab incisions) using O-arm assisted stereotactic navigation. No trauma cases using O-arm assisted navigation had iatrogenic neurovascular injury and none required subsequent revision surgery for implant malposition, compared with a revision rate of 1.2% of patients with non-navigated acute spinal trauma during the same interval. Technical factors associated with successful application of this technology in the setting of acute spinal trauma were detailed. O-arm assisted navigation can overcome anatomical challenges and broaden the available stabilization options in the management of acute spinal trauma. Other advantages include protecting the surgical team from cumulative fluoroscopic radiation exposure and patients from repeat surgery due to implant malposition.
本前瞻性队列研究的目的在于描述术中锥形束 CT（O 臂®，Medtronic，明尼苏达州明尼阿波利斯），常与立体定向导航（StealthStation®，Medtronic）联合使用，在急性脊柱创伤手术治疗中的新作用。从前瞻性收集的脊柱数据库中确定了 2009 年 5 月至 2011 年 5 月期间所有使用 O 臂治疗的急性脊柱创伤患者，并进行回顾性分析以确定适应证和结果。在两年期间，O 臂在 183 例脊柱手术中使用；其中 27 例（15%）涉及急性脊柱创伤。在创伤组中，14 例损伤位于颈椎，9 例位于颈胸交界处，4 例位于胸腰椎。在 12 例患者（44%）中，存在先前存在的异常和具有挑战性的解剖结构，通常是强直性脊柱炎。手术技术包括经关节寰枢固定和通过 O 臂辅助立体定向导航完全经皮（通过两个刺切口）直接进行 Hangman 骨折的骨合成。与同一时间段内非导航急性脊柱创伤患者的 1.2%的翻修率相比，使用 O 臂辅助导航的创伤病例没有医源性神经血管损伤，也不需要因植入物位置不当而进行后续翻修手术。详细介绍了在急性脊柱创伤中成功应用该技术的技术因素。O 臂辅助导航可以克服解剖学挑战，并拓宽急性脊柱创伤治疗中的可用稳定选择。其他优点包括保护手术团队免受累积的荧光透视辐射暴露和患者因植入物位置不当而重复手术。
