Theologis Alexander A, Burch Shane
From the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Spine (Phila Pa 1976). 2015 Sep 15;40(18):1397-406. doi: 10.1097/BRS.0000000000001026.
Retrospective analysis.
To determine safety and efficacy of cervical pedicle screw placement using O-Arm and Stealth Navigation in patients with cervicothoracic spinal deformities and revision subaxial cervical pathology.
Cervical pedicle screws are biomechanically advantageous to other posterior cervical fixation techniques; however, their use is limited by concerns for neurovascular injury. Few clinical reports exist on their placement safety and efficacy using modern navigation systems.
Adults who had cervical pedicle screws inserted using O-Arm and Stealth Navigation between November 2007 and January 2014 and with a minimum 1-year follow-up were retrospectively studied. Screw insertion safety, surgical complications, need for reoperation, and clinical outcomes [Neck Disability Index, EQ-5D, numeric pain rating scales] were evaluated.
21 patients (female-10; male-11; average age 63 yr [32-83 yr]) met inclusion criteria. Average follow-up was 29.8 months (12-81.6 mo). Reconstruction of C2 and the subaxial cervical spine included 8 primary operations for cervicothoracic kyphosis and 13 revision operations. 121 pedicle screws were placed (C2: 4, C3: 20, C4: 22, C5: 23, C6: 18, C7: 34) using Stealth Navigation. The average number of screws placed per case was 6 (1-12). Greater than 99% of screws were placed safely without neurovascular injury. 1 screw (0.8%) was noted postoperatively to critically breach the medial wall and was associated with an acute C5 nerve root palsy. 2 patients required revisions for postoperative iatrogenic foraminal stenosis and associated C8 radiculopathies. No vascular complications due to aberrant screw placement occurred. There were significant improvements (P < 0.05) in EQ-5D utility scores and neck and arm pain. Neck Disability Index scores decreased on average by 10 points (P = 0.12).
Placement of cervical pedicle screws using O-Arm/Stealth Navigation in this series was a safe and effective method for posterior stabilization in cervicothoracic deformity and revision operations of the subaxial cervical spine.
回顾性分析。
确定在患有颈胸段脊柱畸形和下颈椎翻修病变的患者中，使用O型臂和术中神经导航系统置入颈椎椎弓根螺钉的安全性和有效性。
颈椎椎弓根螺钉在生物力学方面优于其他颈椎后路固定技术；然而，其应用因担心神经血管损伤而受到限制。关于使用现代导航系统置入颈椎椎弓根螺钉的安全性和有效性的临床报告很少。
对2007年11月至2014年1月期间使用O型臂和术中神经导航系统置入颈椎椎弓根螺钉且至少随访1年的成年患者进行回顾性研究。评估螺钉置入的安全性、手术并发症、再次手术的必要性以及临床结果[颈部功能障碍指数、EQ-5D量表、数字疼痛评分量表]。
21例患者（女性10例；男性11例；平均年龄63岁[32 - 83岁]）符合纳入标准。平均随访时间为29.8个月（12 - 81.6个月）。C2和下颈椎的重建包括8例治疗颈胸段后凸畸形的初次手术和13例翻修手术。使用术中神经导航系统置入了121枚椎弓根螺钉（C2：4枚，C3：20枚，C4：22枚，C5：23枚，C6：18枚，C7：34枚）。每例患者平均置入螺钉6枚（1 - 12枚）。超过99%的螺钉安全置入，未发生神经血管损伤。术后发现1枚螺钉（0.8%）严重突破内侧壁，并伴有急性C5神经根麻痹。2例患者因术后医源性椎间孔狭窄及相关的C8神经根病需要翻修。未发生因螺钉置入异常导致的血管并发症。EQ-5D效用评分以及颈部和手臂疼痛有显著改善（P < 0.05）。颈部功能障碍指数评分平均下降10分（P = 0.12）。
在本系列研究中，使用O型臂/术中神经导航系统置入颈椎椎弓根螺钉是颈胸段畸形后路稳定和下颈椎翻修手术的一种安全有效的方法。
4级。
