Miller James A, Fabiano Andrew J
Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
World Neurosurg. 2017 Sep;105:412-419. doi: 10.1016/j.wneu.2017.06.016. Epub 2017 Jun 10.
Spinal neuronavigation improves accuracy of pedicle screw placement but may increase operative time, and its use in oncologic operations remains relatively unstudied. We compared the use of two-dimensional (2D) fluoroscopy and three-dimensional (3D) spinal neuronavigation relative to operative time in instrumented oncology procedures.
Consecutive instrumented oncologic spinal operations for multiple myeloma or metastatic disease performed between 2012 and 2014 were retrospectively reviewed. Patients were placed in 2 groups based on the method used for pedicle screw placement: 2D fluoroscopy versus spinal neuronavigation with 3D imaging. These groups were compared by age, number of screws placed, number of laminectomy levels, operative time, estimated blood loss, length of hospital stay after surgery, and rate of reoperation as a result of screw misplacement.
Fourteen operations used 2D fluoroscopy and 25 used spinal neuronavigation. In the fluoroscopy and neuronavigation groups, respectively, patient ages were 64.71 ± 7.21 years and 63.24 ± 6.95 years (P = 0.534), number of screws was 8.07 ± 1.98 and 7.84 ± 1.34 (P = 0.667), laminectomy levels were 2.18 ± 1.25 and 1.60 ± 1.02 (P = 0.126), operative time was 200.79 ± 34.99 minutes and 193.48 ± 43.77 minutes (P = 0.596), estimated blood loss was 790.00 ± 769.61 mL and 389.80 ± 551.43 mL (P = 0.068), and length of stay after the operation was 7.64 ± 4.63 days and 6.40 ± 3.23 days (P = 0.331). One patient in the 2D fluoroscopy group and no patients in the spinal neuronavigation group required a reoperation for screw misplacement.
There was no significant difference in length of operative time when neuronavigation was compared with fluoroscopy for instrumented oncologic spinal surgery. There was a trend toward a decrease in estimated blood loss in the neuronavigation cases.
脊柱神经导航可提高椎弓根螺钉置入的准确性，但可能会增加手术时间，且其在肿瘤手术中的应用研究相对较少。我们比较了在肿瘤脊柱手术中使用二维（2D）荧光透视和三维（3D）脊柱神经导航对手术时间的影响。
回顾性分析2012年至2014年间连续进行的多例骨髓瘤或转移性疾病的肿瘤脊柱器械手术。根据椎弓根螺钉置入方法将患者分为两组：2D荧光透视组与3D成像的脊柱神经导航组。比较两组患者的年龄、置入螺钉数量、椎板切除节段数、手术时间、估计失血量、术后住院时间以及因螺钉误置导致的再次手术率。
14例手术使用2D荧光透视，25例使用脊柱神经导航。荧光透视组和神经导航组患者年龄分别为64.71±7.21岁和63.24±6.95岁（P = 0.534），螺钉数量分别为8.07±1.98枚和7.84±1.34枚（P = 0.667），椎板切除节段数分别为2.18±1.25个和1.60±1.02个（P = 0.126），手术时间分别为200.79±34.99分钟和193.48±43.77分钟（P = 0.596），估计失血量分别为790.00±769.61 mL和389.80±551.43 mL（P = 0.068），术后住院时间分别为7.64±4.63天和6.40±3.23天（P = 0.331）。2D荧光透视组有1例患者因螺钉误置需要再次手术，脊柱神经导航组无患者因螺钉误置需要再次手术。
在肿瘤脊柱器械手术中，神经导航与荧光透视相比，手术时间长度无显著差异。神经导航病例的估计失血量有减少趋势。
