Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Oper Neurosurg (Hagerstown). 2019 Apr 1;16(4):445-450. doi: 10.1093/ons/opy162.
Pedicle subtraction osteotomy (PSO) at the cervicothoracic junction (CTJ) is a powerful technique to correct severe kyphosis and sagittal malalignment. Reported techniques have demonstrated the safety and efficacy of the PSO, however limited visualization of surrounding tissues increases the potential for complications with this advanced technique.
To describe the application of computed tomographic (CT)-based image guidance to the planning and execution of PSO at the CTJ.
Intraoperative registration and verification of anatomic landmarks are performed with the intraoperative O-arm CT across the CTJ. With the navigation probe, the targeted pedicle is identified and the intended trajectories are rehearsed and saved on the navigational computer. As the PSO is performed, the navigation probe is used to check the depth, accuracy, and trajectory through each side. The extent of soft tissue dissection around the lateral aspect of the vertebral body through which the PSO is performed is also verified in real time. This technique was performed in 12 consecutive patients from 2013-2016. An IRB approved, retrospective analysis was performed from a prospective spinal deformity outcomes database. Patient consent is not required for publication as this report does not describe a specific case but rather a surgical technique used in practice.
There were no vascular, esophageal, or soft tissue injuries in 12 consecutive patients. There were no cases of paralysis. Two patients developed hand weakness days after surgery. Intraoperative O-arm CT performed after closure of the osteotomy confirmed the accuracy of the osteotomy planning with no breach of the anterior cortical wall of the osteotomized vertebral body.
CT-guided navigation allows for 3-dimensional visualization of the CTJ and minimizes complications associated with inadequate surgical visualization of vascular and deep organ structures.
颈椎胸椎交界处（CTJ）的椎弓根切除截骨术（PSO）是矫正严重后凸畸形和矢状面失平衡的有效方法。已有报道的技术已经证明了 PSO 的安全性和有效性，然而，由于周围组织的可视性有限，这种先进技术存在并发症的潜在风险。
描述基于计算机断层扫描（CT）的图像引导在 CTJ 行 PSO 中的应用。
在 CTJ 处使用术中 O 臂 CT 进行术中注册和验证解剖标志。使用导航探针识别目标椎弓根，并对预期轨迹进行排练和保存在导航计算机上。当进行 PSO 时，导航探针用于检查每一侧的深度、准确性和轨迹。还实时验证了通过 PSO 进行的椎体侧方周围软组织的剥离程度。该技术于 2013 年至 2016 年在 12 例连续患者中进行。对前瞻性脊柱畸形结果数据库进行了一项经机构审查委员会批准的回顾性分析。由于本报告没有描述特定病例，而是描述了实际使用的手术技术，因此无需患者同意即可发表。
在 12 例连续患者中，没有发生血管、食管或软组织损伤。没有瘫痪病例。2 例患者在手术后数天出现手部无力。在关闭截骨术后进行的术中 O 臂 CT 证实了截骨术计划的准确性，没有穿透截骨椎体的前皮质壁。
CT 引导导航允许对 CTJ 进行三维可视化，并最大限度地减少因血管和深部器官结构的手术可视化不足而导致的并发症。
