Shimokawa Nobuyuki, Abe Junya, Satoh Hidetoshi, Arima Hironori, Takami Toshihiro
Department of Neurosurgery, Tsukazaki Hospital.
Neurol Med Chir (Tokyo). 2016 Aug 15;56(8):493-500. doi: 10.2176/nmc.oa.2015-0334. Epub 2016 Apr 11.
Significant progress has been made in image-guided surgery (IGS) over the last few decades. IGS can be effectively applied to spinal instrumentation surgery. In the present study, we focused our attention on the feasibility and safety of image-guided spine stabilization for traumatic or osteoporotic spine injury. The IGS spine fixation with or without minimally invasive surgery (MIS) techniques such as percutaneous screw placement, balloon kyphoplasty (BKP), or vertebroplasty (VP) were accomplished in 80 patients with traumatic or osteoprotic spine injury between 2007 and 2015. The injured vertebral levels included the following: cervical spine, 41; thoracic spine, 22; and lumbar spine, 17. Neurological condition before and after surgery was assessed using the American Spinal Injury Association Impairment Scale (AIS). A total of 419 pedicle, lateral mass, or laminar screws were placed, and 399 screws (95.2%) were found to be placed correctly based on postoperative computed tomography scan. Although 20 screws (4.8%) were found to be unexpectedly placed incorrectly, no neural or vascular complications closely associated with screw placement were encountered. Neurological outcomes appeared to be acceptable or successful based on AIS. The IGS is a promising technique that can improve the accuracy of screw placement and reduce potential injury to critical neurovascular structures. The integration of MIS and IGS has proved feasible and safe in the treatment of traumatic or osteoporotic spine injury, although a thorough knowledge of surgical anatomy, spine biomechanics, and basic technique remain the most essential aspects for a successful surgery.
在过去几十年里,图像引导手术(IGS)取得了重大进展。IGS可有效应用于脊柱内固定手术。在本研究中,我们重点关注图像引导下脊柱稳定术治疗创伤性或骨质疏松性脊柱损伤的可行性和安全性。2007年至2015年间,对80例创伤性或骨质疏松性脊柱损伤患者实施了采用或不采用诸如经皮螺钉置入、球囊后凸成形术(BKP)或椎体成形术(VP)等微创手术(MIS)技术的IGS脊柱固定术。损伤的椎体节段包括:颈椎41个;胸椎22个;腰椎17个。使用美国脊髓损伤协会损伤量表(AIS)评估手术前后的神经状况。共置入419枚椎弓根、侧块或椎板螺钉,根据术后计算机断层扫描,发现399枚螺钉(95.2%)置入正确。尽管发现20枚螺钉(4.8%)意外置入错误,但未遇到与螺钉置入密切相关的神经或血管并发症。基于AIS,神经学结果似乎是可接受的或成功的。IGS是一种有前景的技术,可提高螺钉置入的准确性并减少对关键神经血管结构的潜在损伤。尽管对手术解剖学、脊柱生物力学和基本技术的透彻了解仍然是成功手术的最关键方面,但MIS与IGS的结合已被证明在治疗创伤性或骨质疏松性脊柱损伤方面是可行和安全的。