Department of Neurosurgery, University of Rochester Medical Center, Rochester.
Department of Neurosurgery, SUNY Upstate Medical University.
Clin Spine Surg. 2020 Aug;33(7):E317-E321. doi: 10.1097/BSD.0000000000000949.
Retrospective cohort series.
The objective of this study was to determine if the use of image-guided navigation offers a clinically significant advantage over fluoroscopy-assisted pedicle screw and non-navigated screw placement in reducing the risk of revision surgery for malpositioned screws in instrumented spinal surgery.
Use image-guided navigation has become increasingly commonplace in instrumented spine surgery, but there is a lack of information regarding differences in the rates of clinically relevant screw malposition with image-guided compared with non-navigated screw placement.
This is a retrospective cohort series of consecutive patients who underwent instrumented spinal surgery by the senior authors at 2 academic tertiary care centers in New York.
A total of 663 instrumented spinal surgeries were analyzed, including 271 instances with image-guided navigation. For the image-guided navigation cohort, 110 of the patients underwent screw placement using O-Arm image-guidance, yielding data on 1115 screws. The remaining 161 surgeries utilizing image-guided screw placement were performed using Brainlab Spine Navigation, for a total of 1001 screws. A fluoroscopy-assisted technique or freehand technique was used in 419 instances, with a total of 3689 screws. Of the non-navigated cohort, 10 patients required a surgical revision of screw placement, for a total of 15 malpositioned screws. Amongst the image-guided navigation cohort, 1 patient in the O-Arm group and 2 in the Brainlab group required revision surgery, with 3 malpositioned screws in total. The rate of revision surgery for a malpositioned screw placed via non-navigated techniques was 2.39%. This risk was decreased to 1.11% with the use of the intraoperative image-guided navigation. However, no comparisons between non-navigated and image-guided screw placement reached statistical significance.
Although not reaching statistical significance, these data suggest there may be an advantage offered by image-guided screw placement in instrumented spinal surgery.
回顾性队列研究。
本研究旨在确定与透视辅助椎弓根螺钉和非导航螺钉放置相比，在减少因置钉位置不当而需翻修手术的风险方面，影像引导导航的使用是否具有临床显著优势。
影像引导导航在脊柱内固定手术中的应用越来越普遍，但关于影像引导与非导航螺钉放置相比，在螺钉位置不当的临床相关发生率方面的差异，信息仍然缺乏。
这是一项在纽约的 2 个学术性三级护理中心由资深作者进行的连续患者的回顾性队列研究。
共分析了 663 例脊柱内固定手术，其中 271 例使用影像导航。对于影像导航组，110 例患者使用 O-Arm 影像导航进行螺钉放置，获得了 1115 枚螺钉的数据。其余 161 例使用影像引导螺钉放置的手术使用 Brainlab Spine Navigation 进行，总共 1001 枚螺钉。419 例采用透视辅助或徒手技术，总共 3689 枚螺钉。在非导航组中，有 10 例患者需要对螺钉位置进行手术修正，总共 15 枚螺钉位置不当。在影像导航组中，O-Arm 组中有 1 例和 Brainlab 组中有 2 例患者需要进行翻修手术，总共 3 枚螺钉位置不当。非导航技术放置的螺钉位置不当的翻修手术率为 2.39%。使用术中影像导航可将这一风险降低至 1.11%。然而，非导航和影像引导螺钉放置之间没有任何比较达到统计学意义。
尽管没有达到统计学意义，但这些数据表明，影像引导螺钉放置在脊柱内固定手术中可能具有优势。
