Elmi-Terander Adrian, Skulason Halldor, Söderman Michael, Racadio John, Homan Robert, Babic Drazenko, van der Vaart Nijs, Nachabe Rami
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Spine (Phila Pa 1976). 2016 Nov 1;41(21):E1303-E1311. doi: 10.1097/BRS.0000000000001830.
A cadaveric laboratory study.
The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN).
Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine.
ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches.
ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method.
ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement.
N/A.
尸体实验室研究。
本研究旨在评估使用增强现实手术导航（ARSN）进行胸椎椎弓根螺钉置入的可行性和准确性。
脊柱导航的最新进展表明，腰骶椎弓根螺钉置入的准确性有所提高，但在胸椎中的益处有限。三维术中成像和器械导航可在不使用X线透视的情况下提高椎弓根螺钉置入的准确性，从而为胸椎的影像引导微创治疗开辟了道路。
ARSN包括手术台、具有术中二维/三维功能的电动平板探测器C形臂、用于增强现实导航的集成光学相机以及无创患者运动跟踪。两名神经外科医生在四具尸体的胸椎上，在脊柱一侧使用ARSN置入94枚椎弓根螺钉（47枚螺钉），对侧采用徒手技术。两种技术均未使用X线透视。四名独立 reviewers 使用Gertzbein分级评估术后扫描结果。对椎弓根的轴向和矢状宽度及角度以及椎体的轴向和矢状旋转进行形态学测量，以确定突破的危险因素。
ARSN在总体准确性方面是可行的，且优于徒手技术（85%对64%，P<0.05），特别是完全置入螺钉的比例显著增加（51%对30%，P<0.05），超过4毫米的突破减少（2%对25%，P<0.05）。除椎体轴向旋转外，所有形态学维度在采用徒手方法时都是更大突破的危险因素。
无透视的ARSN是可行的，并且在胸椎椎弓根螺钉置入方面显示出比徒手技术更高的准确性。
无。
