Yu James Y H, Fridley Jared, Gokaslan Ziya, Telfeian Albert, Oyelese Adetokunbo A
Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA.
World Neurosurg. 2019 Feb;122:e1266-e1274. doi: 10.1016/j.wneu.2018.11.027. Epub 2018 Nov 14.
Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy.
A retrospective review and analysis was performed of the cases of 20 patients with thoracolumbar burst fractures surgically managed via mini-open lateral corpectomy with fluoroscopy (2013-2015) or iCT navigation (2015-2017). The surgical outcomes were evaluated by the estimated blood loss, operative time, hospital stay, and need for revision. The clinical outcomes were evaluated using the numerical rating scale pain score. Radiographic outcomes were assessed with follow-up CT scans. The results were statistically analyzed using the Wilcoxon-Mann-Whitney test.
The mean follow-up period was 13.4 months for the fluoroscopy group and 14.7 months for the iCT group. No surgical complications developed and no revisions were required. No statistically significant differences were found between the groups in surgical or clinical outcomes. However, the radiation exposure to the surgeons was significantly less with the iCT group (P < 0.003).
The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons.
采用微小切口侧方胸膜后或腹膜后入路进行椎体切除术的微创手术是治疗不稳定型胸腰椎爆裂骨折的一种已被充分描述的手术方法。大多数外科医生已将荧光透视用于定位和确定内固定置入的准确性；然而，计算机辅助影像引导脊柱导航的效用尚未得到充分描述。我们报告一系列采用荧光透视或术中计算机断层扫描（iCT）及计算机辅助导航的微小切口侧方入路胸腰椎椎体切除病例，并讨论使用iCT导航与荧光透视相比的技术细微差别和优势。
对20例通过微小切口侧方椎体切除术采用荧光透视（2013 - 2015年）或iCT导航（2015 - 2017年）进行手术治疗的胸腰椎爆裂骨折患者的病例进行回顾性分析。通过估计失血量、手术时间、住院时间和翻修需求来评估手术结果。使用数字评定量表疼痛评分评估临床结果。通过随访CT扫描评估影像学结果。使用Wilcoxon - Mann - Whitney检验对结果进行统计学分析。
荧光透视组的平均随访期为13.4个月，iCT组为14.7个月。未发生手术并发症，也无需翻修。两组在手术或临床结果方面未发现统计学上的显著差异。然而，iCT组外科医生所受的辐射暴露明显更少（P < 0.003）。
对于胸腰椎爆裂骨折的微小切口侧方椎体切除术，使用iCT与脊柱导航产生的围手术期和临床结果与使用传统荧光透视相当，同时减少了外科医生所受的辐射暴露。
