Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Anesthesiology and Surgical Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2018 Mar 1;43(5):370-377. doi: 10.1097/BRS.0000000000002173.
A prospective case-series study and a retrospective analysis of historical patients for comparison of data.
To compare accuracy and limitations of intraoperative computed tomography (iCT)- versus 3D C-arm-based spinal navigation for posterior pedicle screw implantation.
Despite the higher accuracy of navigated compared to non-navigated pedicle screw implantation, it remains a matter of debate whether the use of iCT imaging may further benefit navigated spinal instrumentation compared to more commonly used isocentric 3D C-arm imaging.
Between 2013 and 2016, 1527 pedicle screws were implanted in 260 patients with iCT (1219 screws) or 3D C-arm (308 screws)-based spinal navigation. Screw positioning was intraoperatively assessed by a second iCT or 3D C-arm (intraoperative accuracy). If necessary, immediate intraoperative screw revision was performed. Thereafter, a third iCT or 3D C-arm scan was performed to confirm repositioning (final accuracy). Clinical and patient data, intraoperative screw assessability, and accuracy rates were retrospectively reviewed and analyzed by an independent observer.
Intraoperative CT permitted immediate intraoperative assessment of each implanted screw. In contrast, 39 of the screws visualized with 3D C-arm imaging were intraoperatively not clearly assessable. Regarding the overall precision, iCT and 3D C-arm navigation yielded a comparable intraoperative accuracy (iCT 94.7% vs 3D C-arm 89.4%) and immediate correction of misplaced screws was feasible with both modalities (final accuracy: iCT 95.4% vs 3D C-arm 91.6%). Regarding the region specific performance, however, iCT-based navigation yielded significantly higher final accuracy rates in the cervical (iCT 99.5% vs 3D C-arm 88.9%, P < 0.01) and thoracic (iCT 97.7% vs 3D C-arm 88.8%, P < 0.001) regions.
Both iCT and 3D C-arm-based spinal navigation provides high pedicle screw accuracy rates. Immediate screw assessability and placement accuracy in the cervical-thoracic spine, however, appear to be limited with intraoperative 3D C-arm imaging alone.
前瞻性病例系列研究和历史患者回顾性分析，以比较数据。
比较术中计算机断层扫描（iCT）与 3D C 臂脊柱导航在后路椎弓根螺钉植入中的准确性和局限性。
尽管导航植入的准确性高于非导航植入，但使用 iCT 成像是否能进一步提高导航脊柱器械的准确性，仍存在争议，而 3D C 臂成像则更为常用。
2013 年至 2016 年间，260 例患者（1219 枚螺钉）采用 iCT（1219 枚螺钉）或 3D C 臂（308 枚螺钉）脊柱导航进行 1527 枚椎弓根螺钉植入。术中通过第二台 iCT 或 3D C 臂（术中准确性）评估螺钉定位。如有必要，立即进行术中螺钉修正。然后，再进行第三台 iCT 或 3D C 臂扫描以确认重新定位（最终准确性）。由独立观察者回顾性分析临床和患者数据、术中螺钉可评估性和准确性。
术中 CT 允许立即评估每个植入的螺钉。相比之下，3D C 臂成像可见的 39 枚螺钉术中无法明确评估。在整体精度方面，iCT 和 3D C 臂导航的术中准确性相当（iCT 为 94.7%，3D C 臂为 89.4%），两种方式均可对位置不当的螺钉进行即时校正（最终准确性：iCT 为 95.4%，3D C 臂为 91.6%）。然而，就区域特定性能而言，iCT 导航在颈椎（iCT 为 99.5%，3D C 臂为 88.9%，P<0.01）和胸椎（iCT 为 97.7%，3D C 臂为 88.8%，P<0.001）区域的最终准确性更高。
iCT 和 3D C 臂脊柱导航都能提供较高的椎弓根螺钉准确性。然而，仅使用术中 3D C 臂成像，颈椎-胸椎的螺钉即时评估和放置准确性似乎有限。
3 级。
