Dunn Conor, Faloon Michael, Milman Edward, Pourtaheri Sina, Sinah Kumar, Hwang Ki, Emami Arash
Seton Hall University School of Health and Medical Science, Wayne, NJ, USA.
Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA.
Asian Spine J. 2018 Apr;12(2):238-245. doi: 10.4184/asj.2018.12.2.238. Epub 2018 Apr 16.
STUDY DESIGN: Retrospective case series with prospective arm. PURPOSE: To assess the safety and accuracy of percutaneous lumbosacral pedicle screw placement (PLPSP) in the lumbosacral spine using intraoperative dual-planar fluoroscopy (DPF). OVERVIEW OF LITERATURE: There are several techniques available for achieving consistent, safe, and accurate results with PLPSP. There is a paucity of literature describing the beneficial operative, economic, and clinical outcomes of DPF, the most readily accessible image guidance system. METHODS: From 2004 to 2014, 451 consecutive patients underwent PLPSP using DPF, for a total of 2,345 screw placement. The results of prospectively obtained postoperative computed tomography (CT) examinations of an additional 41 consecutive patients were compared with the results of 104 CT examinations obtained postoperatively due to clinical symptomatology; these results were interpreted by three reviewers. The rates of revision indicated by misplaced screws with consistent clinical symptomatology were compared between groups. Pedicle screw placement was graded according to 2-mm increments in medial pedicle wall breach and measurement of screw axis placement. RESULTS: Seven of the 2,345 pedicle screws placed percutaneously with the use of the dual-planar fluoroscopic technique required revision because of a symptomatic misplaced screw, for a screw revision rate of 0.3%. There were no statistically significant demographic differences between patients who had screws revised and those who did not. All screws registered greater than 10 mA on electromyographic stimulation. In the 41 prospectively obtained CT examinations, one out of 141 screws (0.7%) was revised due to pedicle wall breach; whereas among the 104 patients with 352 screws, three screws were revised (0.9%). CONCLUSIONS: DPF is an extremely accurate, safe, and reproducible technique for placement of percutaneous pedicle screws and is a readily available and cost-effective alternative to CT-guided pedicle screw placement techniques. Postoperative CT evaluation is not necessary with PLPSP unless the patient is symptomatic. Acceptable electromyographic thresholds may need to be reevaluated.
研究设计：带有前瞻性研究组的回顾性病例系列研究。 目的：使用术中双平面透视（DPF）评估经皮腰骶椎椎弓根螺钉置入术（PLPSP）在腰骶椎的安全性和准确性。 文献综述：有多种技术可用于实现PLPSP的一致、安全和准确的结果。描述DPF（最易于使用的图像引导系统）有益的手术、经济和临床结果的文献较少。 方法：2004年至2014年，451例连续患者接受了使用DPF的PLPSP，共置入2345枚螺钉。将另外41例连续患者前瞻性获得的术后计算机断层扫描（CT）检查结果与因临床症状而术后获得的104例CT检查结果进行比较；这些结果由三位评估者解读。比较两组中因螺钉位置不当且伴有一致临床症状而需翻修的比例。根据椎弓根内侧壁破裂2毫米的增量和螺钉轴线位置的测量对椎弓根螺钉置入进行分级。 结果：使用双平面透视技术经皮置入的2345枚椎弓根螺钉中有7枚因有症状的螺钉位置不当而需要翻修，螺钉翻修率为0.3%。翻修螺钉的患者与未翻修螺钉的患者在人口统计学上无统计学显著差异。所有螺钉在肌电图刺激时记录的电流均大于10毫安。在41例前瞻性获得的CT检查中，141枚螺钉中有1枚（0.7%）因椎弓根壁破裂而翻修；而在104例有352枚螺钉的患者中，有3枚螺钉翻修（0.9%）。 结论：DPF是一种用于经皮椎弓根螺钉置入的极其准确、安全且可重复的技术，是CT引导椎弓根螺钉置入技术的一种易于获得且具有成本效益的替代方法。除非患者有症状，否则PLPSP术后无需进行CT评估。可能需要重新评估可接受的肌电图阈值。
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