Rodriguez Analiz, Neal Matthew T, Liu Ann, Somasundaram Aravind, Hsu Wesley, Branch Charles L
Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Neurosurg Focus. 2014 Mar;36(3):E9. doi: 10.3171/2014.1.FOCUS13521.
Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation.
The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained.
The average patient age was 69.4 years (range 58-82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175-315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2-3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10-15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B.
The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.
腰椎融合术后出现的症状性相邻节段腰椎疾病（ASLD）通常需要后续手术干预。作者报告了利用皮质骨轨迹（CBT）椎弓根螺钉固定术并结合术中CT（O型臂）图像引导导航技术来稳定症状性ASLD患者的脊柱节段。这种独特的技术可在同一椎弓根内植入2枚螺钉（1枚传统椎弓根轨迹螺钉和1枚CBT螺钉），并且无需移除先前植入的器械。
回顾性分析5例连续接受CBT腰椎融合术及后路椎间植骨治疗ASLD患者的病历资料。所有患者均使用O型臂结合StealthStation导航系统进行螺钉轨迹规划。收集患者的基本人口统计学资料、手术细节以及影像学和临床结果。
患者平均年龄为69.4岁（范围58 - 82岁）。5例手术中有4例采用了微创脊柱技术（MAST）中线腰椎融合（MIDLF）系统。平均手术时长为218分钟（范围175 - 315分钟）。在整个队列中，在先前已植入器械的椎弓根内植入了5.5毫米的皮质螺钉。平均住院时间为2.8天（范围2 - 3天），且无手术并发症。所有患者均有超过6个月的影像学和临床随访（范围10 - 15个月）。在最后一次随访时，所有患者均报告其症状较术前有所改善。影像学随访显示Lenke融合分级为A或B级。
作者介绍了一种新型融合技术，即在先前已植入器械的椎弓根内使用CBT椎弓根螺钉固定术，并结合术中O型臂引导导航。该方法无需移除内固定物。这组患者取得了良好的临床效果。计算机断层扫描导航对于在先前已为症状性ASLD植入传统椎弓根螺钉的节段准确置入CBT螺钉至关重要。
