Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R, Eysel P, Koy T
Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Department of Radiology, University Hospital of Cologne, Cologne, Germany.
Eur Spine J. 2015 Dec;24(12):2967-76. doi: 10.1007/s00586-015-3974-2. Epub 2015 Apr 30.
Due to better primary stability and repositioning options, pedicle screws are increasingly used during posterior stabilization of the cervical spine. However, the serious risks generally associated with the insertion of screws in the cervical spine remain. The purpose of this study is to examine the accuracy of pedicle screw insertion with the use of 3D fluoroscopy navigation systems, also accounting for various spine levels.
Data of 64 patients were collected during and after screw implantation (axial and subaxial) in the cervical spine. 207 screws were implanted from C1 to C7 and analyzed for placement accuracy according to postoperative CT scans and following the modified Gertzbein and Robbins classification.
The accuracy of most of the inserted screws was assessed as grade 2 according to the modified Gertzbein and Robbins classification. 93.9% of the screws implanted at C1 or C2, and 78.51% of the screws implanted at levels C3-C7 showed placement accuracy grade 2 or better, indicating pedicle wall perforation of <2 mm. Overall, seven complications were observed. In three cases, the vertebral artery was affected, leading to one fatality. Surgical revision was necessary once because of Magerl screw misplacement and three times due to impaired wound healing. No radicular symptoms resulted from screw malposition.
Axial and subaxial screws can be inserted with a high grade of accuracy using 3D fluoroscopy-based navigation systems. Nevertheless, while this useful innovation helps to minimize the risks of misplacement, the surgery is still a challenge, as arising complications remain severe.
由于具有更好的初始稳定性和重新定位选择，椎弓根螺钉在颈椎后路稳定手术中的使用越来越多。然而，颈椎螺钉植入通常仍存在严重风险。本研究的目的是使用三维透视导航系统检查椎弓根螺钉植入的准确性，并考虑不同的脊柱节段。
收集了64例患者在颈椎（枢椎和下颈椎）螺钉植入期间及之后的数据。共植入207枚从C1至C7的螺钉，并根据术后CT扫描以及改良的Gertzbein和Robbins分类法分析其植入准确性。
根据改良的Gertzbein和Robbins分类法，大多数植入螺钉的准确性被评估为2级。在C1或C2节段植入的螺钉中有93.9%，在C3 - C7节段植入的螺钉中有78.51%显示植入准确性为2级或更高，表明椎弓根壁穿孔小于2毫米。总体而言，观察到7例并发症。3例中椎动脉受到影响，导致1例死亡。因Magerl螺钉位置不当需进行1次手术翻修，因伤口愈合不良需进行3次手术翻修。螺钉位置不当未导致神经根症状。
使用基于三维透视的导航系统可以高精度地植入枢椎和下颈椎螺钉。然而，尽管这项有益的创新有助于将误置风险降至最低，但手术仍然是一项挑战，因为出现的并发症仍然很严重。
