Janssen Insa, Lang Gernot, Navarro-Ramirez Rodrigo, Jada Ajit, Berlin Connor, Hilis Aaron, Zubkov Micaella, Gandevia Lena, Härtl Roger
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Klinikum rechts der Isar, Munich, Germany.
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA; Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.
World Neurosurg. 2017 Nov;107:322-333. doi: 10.1016/j.wneu.2017.07.167. Epub 2017 Aug 7.
Recently, novel mobile intraoperative fan-beam computed tomography (CT) was introduced, allowing for real-time navigation and immediate intraoperative evaluation of neural decompression in spine surgery. This study sought to investigate whether intraoperatively assessed neural decompression during minimally invasive spine surgery (MISS) has a predictive value for clinical and radiographic outcome.
A retrospective study of patients undergoing intraoperative CT (iCT)-guided extreme lateral interbody fusion or transforaminal lumbar interbody fusion was conducted. 1) Preoperative, 2) intraoperative (after cage implantation, 3) postoperative, and 4) follow-up radiographic and clinical parameters obtained from radiography or CT were quantified.
Thirty-four patients (41 spinal segments) were analyzed. iCT-based navigation was successfully accomplished in all patients. Radiographic parameters showed significant improvement from preoperatively to intraoperatively after cage implantation in both MISS procedures (extreme lateral interbody fusion/transforaminal lumbar interbody fusion) (P ≤ 0.05). Radiologic parameters for both MISS fusion procedures did not show significant differences to the assessed radiographic measures at follow-up (P > 0.05). Radiologic outcome values did not decrease when compared intraoperatively (after cage implantation) to latest follow-up.
Intraoperative fan-beam CT is capable of assessing neural decompression intraoperatively with high accuracy, allowing for precise prediction of radiologic outcome and earliest possible feedback during MISS fusion procedures. These findings are highly valuable for routine practice and future investigations toward finding a threshold for neural decompression that translates into clinical improvement. If sufficient neural decompression has been confirmed with iCT imaging studies, additional postoperative and/or follow-up imaging studies might no longer be required if patients remain asymptomatic.
最近，新型移动式术中扇形束计算机断层扫描（CT）被引入，可用于脊柱手术中神经减压的实时导航和即时术中评估。本研究旨在探讨在微创脊柱手术（MISS）中术中评估的神经减压对临床和影像学结果是否具有预测价值。
对接受术中CT（iCT）引导下极外侧椎间融合术或经椎间孔腰椎椎间融合术的患者进行回顾性研究。对从X线摄影或CT获得的1）术前、2）术中（椎间融合器植入后）、3）术后和4）随访影像学及临床参数进行量化。
分析了34例患者（41个脊柱节段）。所有患者均成功完成基于iCT的导航。在两种MISS手术（极外侧椎间融合术/经椎间孔腰椎椎间融合术）中，影像学参数显示从术前到椎间融合器植入后的术中均有显著改善（P≤0.05）。两种MISS融合手术的放射学参数与随访时评估的放射学测量值相比无显著差异（P>0.05）。与术中（椎间融合器植入后）相比，最新随访时的放射学结果值未降低。
术中扇形束CT能够在术中高精度地评估神经减压情况，从而在MISS融合手术中精确预测放射学结果并提供尽早的反馈。这些发现对于常规实践以及未来寻找能转化为临床改善的神经减压阈值的研究具有极高价值。如果通过iCT成像研究证实了充分的神经减压，且患者仍无症状，则可能不再需要额外的术后和/或随访影像学研究。
