Department of Spine Surgery, Beijing Jishuitan Hospital (4th Clinical Medical College of Peking University), No. 31, Xinjiekou East Street, Xicheng District, 100035 Beijing, People's Republic of China.
Eur Spine J. 2013 Jan;22(1):148-55. doi: 10.1007/s00586-012-2494-6. Epub 2012 Sep 18.
Evaluate the accuracy of five different techniques for lower cervical pedicle screw placement.
Forty human cadaveric cervical spines were equally divided into five groups, and each group had eight specimens. Pedicle screws with dia. 3.5 mm were used. Group 1 was blind screw placement without any assistance; Group 2-5 was assisted by the X-ray fluoroscopy, virtual fluoroscopy navigation system, CT-based navigation system, and Iso-C 3D navigation system, respectively. Thereafter, cortical integrity of each pedicle was evaluated by anatomic dissection of the specimens.
A total of 398 pedicle screws were inserted. In the Group 1-5, the average operation time per sample was 27 ± 3.0, 112 ± 10.3, 69 ± 6.4, 98 ± 11.0, and 91 ± 6.0 min, respectively. The outcome for excellent, fair and poor were 29 (36.3 %), 21 (26.2 %) and 30 (37.5 %) in Group 1; 35 (44.9 %), 29 (37.2 %) and 14 (17.9 %) in Group 2; 34 (42.5 %), 36 (45.0 %) and 10 (12.5 %) in Group 3; 70 (87.5 %), 10 (12.5 %) and 0 (0.0 %) in Group 4; 72 (90.0 %), 8 (10.0 %) and 0 (0.0 %) in Group 5.
Blind screw placement was surely unsafe. Lower cervical pedicle screw placement assisted by the CT-based navigation system or the Iso-C 3D navigation system significantly improved the accuracy compared to the fluoroscopy assistance and the virtual fluoroscopy navigation assistance.
评估五种不同技术在下颈椎椎弓根螺钉置入中的准确性。
将 40 具人尸体颈椎标本等分为 5 组，每组 8 例。使用直径为 3.5mm 的椎弓根螺钉。第 1 组为盲置螺钉，不使用任何辅助手段；第 2-5 组分别采用 X 射线透视、虚拟透视导航系统、基于 CT 的导航系统和 Iso-C 3D 导航系统辅助。然后，通过对标本进行解剖学解剖来评估每个椎弓根的皮质完整性。
共置入 398 枚椎弓根螺钉。在第 1-5 组中，每组样本的平均手术时间分别为 27 ± 3.0、112 ± 10.3、69 ± 6.4、98 ± 11.0 和 91 ± 6.0min。第 1 组的优秀、良好和差的结果分别为 29（36.3%）、21（26.2%）和 30（37.5%）；第 2 组分别为 35（44.9%）、29（37.2%）和 14（17.9%）；第 3 组分别为 34（42.5%）、36（45.0%）和 10（12.5%）；第 4 组分别为 70（87.5%）、10（12.5%）和 0（0.0%）；第 5 组分别为 72（90.0%）、8（10.0%）和 0（0.0%）。
盲目螺钉置入肯定不安全。与透视辅助和虚拟透视导航辅助相比，基于 CT 的导航系统或 Iso-C 3D 导航系统辅助下的下颈椎椎弓根螺钉置入可显著提高准确性。
