Agrawal Deepak
Department of Neurosurgery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Asian J Neurosurg. 2016 Jul-Sep;11(3):298-302. doi: 10.4103/1793-5482.144179.
There is a relatively high incidence of screw misplacement during spinal instrumentation due to distortion of normal anatomy following spinal trauma.
To evaluate and share the initial experience with the use of neuro-navigated 3D O-arm(®) (Medtronic, USA) as compared to traditional 2D fluoroscopy in atrauma center in India.
In this retrospective study, consecutive patients of spinal injury who underwent screw fixation under O-arm guidance over nine-month period (July 2010 till March 2011) were evaluated for accuracy of screw placement. An equal number of consecutive patients prior to March 2011 who underwent screw fixation in 2D fluoroscopy were included for comparison. Patient demographics and radiology were reviewed and spinal injury was assessed using the ASIA grading in both the groups. Screw placement was assessed by postoperative CT scans of the relevant spine and accuracy of screw placement and breach of the medial or lateral cortex of the pedicle were recorded for each case.
In the O-arm group, there were 57 patients in whom 210 screws were inserted. None of the patients had screw mal-placement. In 2D fluoroscopy group, 57 patients had 268 screws insertions. 10 (3.73%) screws were found to be malpositioned in the postoperative CT scans (8 in thoracic spine and 2 in odontoid fractures). The malposition rate was highly significant in 2D fluoroscopy thoracolumbar (P = 0.0015) subgroup. One patient had neurological deterioration and three patients required repositioning of the screws.
In a teaching center with multiple surgeons, the O-arm(®) imaging ensures accurate placement of screws as compared to traditional 2D fluoroscopy.
脊柱创伤后正常解剖结构发生变形，导致脊柱内固定过程中螺钉误置的发生率相对较高。
评估并分享在印度一家创伤中心使用神经导航三维O型臂（美敦力公司，美国）与传统二维透视相比的初步经验。
在这项回顾性研究中，对在九个月期间（2010年7月至2011年3月）接受O型臂引导下螺钉固定的连续脊柱损伤患者进行螺钉置入准确性评估。纳入2011年3月之前在二维透视下接受螺钉固定的同等数量的连续患者进行比较。回顾患者人口统计学和影像学资料，并使用ASIA分级对两组患者的脊柱损伤进行评估。通过相关脊柱的术后CT扫描评估螺钉置入情况，记录每例患者螺钉置入的准确性以及椎弓根内侧或外侧皮质的破损情况。
在O型臂组中，57例患者共置入210枚螺钉。无一例患者出现螺钉误置。在二维透视组中，57例患者共置入268枚螺钉。术后CT扫描发现10枚（3.73%）螺钉位置不当（8枚在胸椎，2枚在齿状突骨折处）。二维透视胸腰椎亚组的误置率具有高度显著性（P = 0.0015）。1例患者出现神经功能恶化，3例患者需要重新调整螺钉位置。
在有多名外科医生的教学中心，与传统二维透视相比，O型臂成像可确保螺钉的准确置入。
