比较腰椎间盘间隙准备与透视、锥形束 CT 和导航：尸体研究。

Comparing Lumbar Disc Space Preparation With Fluoroscopy Versus Cone Beam-Computed Tomography and Navigation: A Cadaveric Study.

机构信息

Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX.

出版信息

Spine (Phila Pa 1976). 2018 Jul 15;43(14):959-964. doi: 10.1097/BRS.0000000000002526.

DOI:10.1097/BRS.0000000000002526

PMID:29280932

Abstract

STUDY DESIGN

Cadaveric study.

OBJECTIVE

This cadaveric study sought to evaluate the efficacy of disc space preparation with cone beam-computed tomography with navigation (CBCT+N) for instrument placement compared with instrument placement with conventional fluoroscopy.

SUMMARY OF BACKGROUND DATA

Disc space preparation from a transforaminal lumbar approach is challenging with respect to visualization, and surgeons currently rely on tactile feel and two-dimensional imaging in the operating room to assess instrument positioning.

METHODS

Two orthopedic spine surgeons performed 40 disc space preparations after eight cadavers were randomly assigned to fluoroscopy versus CBCT+N. Digital images of each vertebral endplate were captured and the percent disc removed by area for the total disc and by quadrants was determined using digital imaging software.

RESULTS

There were 20 lumbar disc levels prepared in the fluoroscopy group. There were 3 thoracolumbar, and 17 lumbar disc levels prepared in the experimental group. Percent disc removed relative to the total area of the disc, as determined by the digital imaging software, was higher in the CBCT+N group (P ≤ 0.0001). More disc was removed in both the anterior contralateral and posterior contralateral quadrants in the CBCT+N group (P = 0.0006 and P ≤ 0.0001 respectively). The intraclass correlation coefficient among blinded reviewers for percent disc removed was 0.759 (95% confidence interval, 0.587-0.866)]. There was no difference in time to complete disc space preparation, number of instrument passes, or number of endplate violations between the two groups (P = 0.28, P = 0.92, and P = 0.34 respectively).

CONCLUSION

The results of this cadaveric investigation reveal that CBCT+N guidance may be used to assess instrument placement for interbody disc space preparation in a similar length of time, with no difference in instrument passes or endplate violations, in comparison with fluoroscopy.

LEVEL OF EVIDENCE

摘要

研究设计

尸体研究。

目的

本尸体研究旨在评估与传统透视相比，锥形束计算机断层扫描导航（CBCT+N）引导下椎间盘空间准备对器械放置的效果。

背景资料概要

经椎间孔腰椎入路的椎间盘空间准备具有挑战性，因为可视化困难，目前外科医生在手术室中依靠触觉和二维成像来评估器械定位。

方法

两名骨科脊柱外科医生在 8 具尸体中随机分配后，分别进行了 40 次椎间盘空间准备，其中 40 次在透视组，40 次在 CBCT+N 实验组。使用数字成像软件对每个椎体终板的数字图像进行捕获，并确定使用数字成像软件确定的总椎间盘和每个象限的椎间盘去除百分比。

结果

透视组共准备了 20 个腰椎间盘水平，实验组准备了 3 个胸腰椎和 17 个腰椎间盘水平。CBCT+N 组（P≤0.0001）的椎间盘去除百分比相对椎间盘总面积更高。在 CBCT+N 组中，前对侧和后对侧象限的椎间盘去除量更多（P=0.0006 和 P≤0.0001）。盲法评估者之间去除的椎间盘百分比的组内相关系数为 0.759（95%置信区间，0.587-0.866）]。两组之间完成椎间盘空间准备的时间、器械通过次数或终板违规次数无差异（P=0.28、P=0.92 和 P=0.34）。