Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
J Neurosurg Spine. 2013 Nov;19(5):608-13. doi: 10.3171/2013.7.SPINE121157. Epub 2013 Sep 6.
Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires.
Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement.
On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures.
Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.
经皮椎弓根螺钉置入技术常用于治疗多种脊柱疾病。通常，在置入时使用克氏针（K）引导丝来引导丝锥和螺钉的插入，因为无法看到正常的解剖学标志。由于透视的使用，K 线的使用会增加血管和神经损伤以及辐射暴露的风险。作者描述了一系列使用新的计算机辅助导航技术而无需使用 K 线的经皮椎弓根螺钉置入患者。
对连续 15 例不同脊柱病变的患者进行微创经皮胸椎和腰椎椎弓根螺钉置入。术中获得 3D CT 图像，并使用计算机辅助导航系统将一个锥-丝锥插入每个椎弓根。导航软件标记丝锥在椎弓根中的位置，然后取出丝锥。导航系统用于识别每个标志以插入椎弓根螺钉。然后在透视引导下经皮插入连接杆。每位患者均获得术后 CT 扫描以评估螺钉放置情况。
术后扫描时，只有 1 枚螺钉有轻微的侧向和上向突破，无症状。迄今为止，尚无硬件故障。
无需使用 K 线即可有效且安全地放置经皮椎弓根螺钉。
