Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Spine (Phila Pa 1976). 2013 Feb 15;38(4):E251-8. doi: 10.1097/BRS.0b013e31827ecbf1.
Retrospective study comparing cranial facet joint violation rates of open and percutaneous pedicle screws inserted using 3-dimensional image-guidance.
To determine the rate of cranial facet joint violation in intraoperative computed tomography (CT) image-guided lumbar pedicle screw instrumentation and compare facet joint violation rates between CT image-guided open and percutaneous techniques.
Facet joint violation by pedicle screws can potentially result in a higher rate of adjacent segment degeneration. Reported cranial facet joint violation rates range from 7% to 100%. Intraoperative image-guidance, which has enhanced pedicle screw placement accuracy, may aid in avoiding impingement of the cranial facet joints.
We reviewed 188 cases of 3-dimensional image-guided lumbar pedicle screw instrumentation from November 2006 to December 2011. The cranial screws of each construct were graded by 3 reviewers according to the Seo classification (0 = no impingement; 1 = screw head in contact/suspected to be in contact with joint; 2 = screw clearly invaded the joint) on intraoperative axial CT images. If there was a difference in evaluation, a consensus was reached to arrive at a single grade. The χ2 test was used to determine significance between the open and percutaneous group (α = 0.05).
A total of 370 screws (245 open, 125 percutaneous) were graded. Overall facet joint violation rate was 18.9% (grade 1 = 16.2%, grade 2 = 2.7%). Open technique (grade 1 = 22.4%, grade 2 = 4.1%) had a significantly higher violation rate than percutaneous technique (grade 1 = 4%, grade 2 = 0%) (P < 0.0001). There is a trend of an increasing likelihood of facet joint violation from L1 to L5.
The use of intraoperative CT image-guidance in lumbar pedicle screw placement resulted in a facet joint violation rate at the lower end of the reported range in literature. The percutaneous technique has a significantly lower facet violation rate than the open technique.
回顾性研究比较了使用三维影像引导的开放和经皮椎弓根螺钉植入时颅侧关节突关节侵犯率。
确定术中计算机断层扫描（CT）影像引导下腰椎椎弓根螺钉内固定术的颅侧关节突关节侵犯率，并比较 CT 影像引导下开放和经皮技术的关节突关节侵犯率。
椎弓根螺钉侵犯关节突关节可能导致相邻节段退变的发生率增加。报道的颅侧关节突关节侵犯率范围为 7%至 100%。术中影像引导提高了椎弓根螺钉的放置准确性，可能有助于避免颅侧关节突关节的撞击。
我们回顾了 2006 年 11 月至 2011 年 12 月期间 188 例三维影像引导下的腰椎椎弓根螺钉内固定术。在术中轴位 CT 图像上，根据 Seo 分级（0=无撞击；1=螺钉头接触/疑似接触关节；2=螺钉明显侵犯关节），由 3 位观察者对每个结构的颅侧螺钉进行分级。如果评估结果存在差异，则通过达成共识得出单一的分级。采用卡方检验（α=0.05）确定开放组和经皮组之间的显著性差异。
共对 370 枚螺钉（245 枚开放，125 枚经皮）进行了分级。总体关节突关节侵犯率为 18.9%（1 级=16.2%，2 级=2.7%）。开放技术（1 级=22.4%，2 级=4.1%）的侵犯率明显高于经皮技术（1 级=4%，2 级=0%）（P<0.0001）。关节突关节侵犯率从 L1 到 L5 有增加的趋势。
在腰椎椎弓根螺钉置入术中使用术中 CT 影像引导可使文献报道的关节突关节侵犯率处于较低水平。经皮技术的关节突侵犯率明显低于开放技术。
4 级。
