Nakhla Jonathan, Bhashyam Niketh, De la Garza Ramos Rafael, Nasser Rani, Kinon Merritt D, Yassari Reza
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA.
Eur Spine J. 2018 Jul;27(7):1575-1585. doi: 10.1007/s00586-017-5406-y. Epub 2017 Dec 15.
To assess the utility of stereotactic navigation for the surgical treatment of ossified, paracentral thoracic discs via a minimally invasive (MI) transpedicular approach.
The authors performed a retrospective review of cases with paracentral thoracic disc herniation resulting in myelopathy where a traditional MI approach would be difficult, who underwent a stereotactic assisted MI transpedicular approach via a tubular retractor system between 2011 and 2016. Five cases of patients over the age of 18 were selected. Collected data included patient age at surgery, sex, preoperative Nurick grade, number of levels treated, calcified disc presence, length of surgery, estimated blood loss (EBL), length of stay (LOS), complication rate, postoperative Nurick grade, and length of follow-up.
Five patients had a stereotaxic assisted MI transpedicular thoracic discectomy for paracentrally located calcified disc herniation. Intraoperative navigational images were acquired using intraoperative CT scans (O-arm) to plan and guide the surgical procedure, and real-time navigation was used for precise navigation around the cord to access and remove all fragments. MIS surgery was successfully performed in these otherwise contraindicated cases due to the use of intraoperative real-time stereotactic navigation. All patients had a successful decompression around the anterior aspect of the cord.
The traditional MI transpedicular thoracic discectomy approach can be further refined and enhanced by stereotactic navigation to expand the limitations of the MIS technique allowing for an increased number and types of patients eligible for minimally invasive surgery. Therefore, MIS via a tubular retractor system with stereotactic navigation is a novel, safe, and effective improvement in feasibility from the traditional minimally invasive transpedicular thoracic discectomy technique.
评估立体定向导航在经微创（MI）经椎弓根入路手术治疗胸椎中央型骨化椎间盘方面的实用性。
作者对2011年至2016年间因胸椎中央型椎间盘突出导致脊髓病且传统MI入路困难的病例进行了回顾性研究，这些患者通过管状牵开器系统接受了立体定向辅助MI经椎弓根入路手术。选择了5例18岁以上的患者。收集的数据包括手术时患者年龄、性别、术前Nurick分级、治疗节段数、是否存在钙化椎间盘、手术时长、估计失血量（EBL）、住院时长（LOS）、并发症发生率、术后Nurick分级以及随访时长。
5例患者接受了立体定向辅助MI经椎弓根胸椎椎间盘切除术，用于治疗中央型钙化椎间盘突出。术中使用术中CT扫描（O型臂）获取导航图像以规划和指导手术过程，并使用实时导航在脊髓周围进行精确导航，以进入并清除所有碎片。由于使用了术中实时立体定向导航，这些原本禁忌的病例成功实施了MIS手术。所有患者在脊髓前方均成功实现减压。
传统的MI经椎弓根胸椎椎间盘切除术方法可通过立体定向导航进一步完善和改进，以扩大MIS技术的局限性，使更多类型的患者有资格接受微创手术。因此，通过带有立体定向导航的管状牵开器系统进行MIS是对传统微创经椎弓根胸椎椎间盘切除术技术在可行性方面的一种新颖、安全且有效的改进。
