Larson A Noelle, Polly David W, Guidera Kenneth J, Mielke Cary H, Santos Edward R G, Ledonio Charles Gerald T, Sembrano Jonathan N
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
J Pediatr Orthop. 2012 Sep;32(6):e23-9. doi: 10.1097/BPO.0b013e318263a39e.
Treatment of congenital spine deformity has high surgical risk due to abnormal anatomy and dysmorphic pedicles. We hypothesized that an image-guided navigation system would result in a low rate of screw revision due to malposition.
From 2007 to 2010, 142 screws were placed in 14 consecutive patients with congenital spine deformity using an intraoperative computer tomography (CT) (O-arm) and image-guided navigation system (Stealth). Mean age was 8.8 years (range, 1 to 18 y). Deformities included scoliosis (12), kyphosis (1), and spinal dysgenesis (1). Screws were placed from T2 to S1. An intraoperative CT verified screw position. Need for intraoperative screw revision is the primary outcome measure.
Of the 142 screws placed, 1 required revision intraoperatively due to malposition (99.3% screw accuracy rate). The screw was at L3 and was successfully redirected. There were no complications due to screw malposition. This navigated congenital screw accuracy rate (99.3%) is higher than the 94.9% accuracy rate reported for non-navigated screws in all children undergoing pedicle screw fixation in a recent systematic literature review and higher than the reported 96.4% accuracy rate for navigated pedicle screws in children. Kosmopoulos and colleagues found a lower accuracy rate (86.6%) in adult non-navigated screws (P<0.0001) and adult navigated screws (93.7%). Of note, 9 pedicles were noted on navigation to be absent. Despite the goal of bilateral screw placement at each fusion level, 31 of 173 pedicles were left unfilled due to technical impossibility based on intraoperative CT imaging. This represents an 18% screw dropout rate.
CT-guided navigation resulted in the successful placement of 142 pedicle screws in patients with congenital deformity and altered anatomy, which represents a 99.3% screw accuracy rate. This is comparable with the screw accuracy rate of 93.7% reported for adult navigated pedicle screws. Further, navigation prevented attempts of screw placement at levels with absent or impassable pedicles. Image-guided navigation and intraoperative CT are valuable tools for the safe placement of pedicle screws in patients with significant congenital spine deformity and altered anatomy.
IV, Case Series.
由于解剖结构异常和椎弓根形态异常，先天性脊柱畸形的治疗具有较高的手术风险。我们推测，图像引导导航系统将导致因位置不当而进行螺钉翻修的发生率较低。
2007年至2010年，连续14例先天性脊柱畸形患者共置入142枚螺钉，术中使用计算机断层扫描（CT）（O型臂）和图像引导导航系统（Stealth）。平均年龄为8.8岁（范围1至18岁）。畸形包括脊柱侧凸（12例）、后凸畸形（1例）和脊柱发育不全（1例）。螺钉从T2置入至S1。术中CT验证螺钉位置。术中螺钉翻修的必要性是主要的观察指标。
在置入的142枚螺钉中，1枚因位置不当需术中翻修（螺钉准确率为99.3%）。该螺钉位于L3，成功重新定位。未发生因螺钉位置不当导致的并发症。这种导航下先天性螺钉的准确率（99.3%）高于最近一项系统文献综述中报道的所有接受椎弓根螺钉固定儿童的非导航螺钉94.9%的准确率，也高于报道的儿童导航椎弓根螺钉96.4%的准确率。科斯莫普洛斯及其同事发现成人非导航螺钉（P<0.0001）和成人导航螺钉（93.7%）的准确率较低（86.6%）。值得注意的是，导航显示9个椎弓根缺如。尽管目标是在每个融合节段双侧置入螺钉，但基于术中CT成像，173个椎弓根中有31个因技术上无法实现而未置入螺钉。这代表螺钉遗漏率为18%。
CT引导导航成功地在先天性畸形和解剖结构改变的患者中置入了142枚椎弓根螺钉，螺钉准确率为99.3%。这与报道的成人导航椎弓根螺钉93.7%的螺钉准确率相当。此外，导航避免了在椎弓根缺如或无法通过的节段尝试置入螺钉。图像引导导航和术中CT是在有严重先天性脊柱畸形和解剖结构改变的患者中安全置入椎弓根螺钉的有价值工具。
IV，病例系列。
