Sumiya Satoshi, Numano Fujiki, Ogawa Takahisa, Yoshii Toshitaka, Okawa Atsushi, Komori Hiromichi
Department of Orthopaedic and Spine Surgery, Yokohama-City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama City, Kanagawa, 231-8682, Japan.
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
BMC Musculoskelet Disord. 2020 Mar 14;21(1):168. doi: 10.1186/s12891-020-3180-1.
The aim of the study was to compare the accuracy of percutaneous pedicle screw (PPS) insertion (P-side) with that of conventional open screw insertion (O-side) during unilateral open transforaminal lumbar interbody fusion (TLIF) in the same patients. We also sought to determine the incidence of pedicle screw misplacement and to identify relevant risk factors.
The study was a retrospective analysis of prospectively collected data for 766 pedicle screws placed in 181 consecutive patients who underwent a unilateral open-TLIF procedure in the lumbosacral spine. Our minimally invasive TLIF was performed by unilateral open freehand insertion of pedicle screws for decompression on one side and PPS on the opposite side. Using this approach, we were able to compare the accuracy of PPS insertion with that of conventional open screw insertion in the same patients. There were 383 PPSs and 383 screws inserted by the open method. The accuracy of screw placement was evaluated on reconstructed computed tomography images obtained postoperatively, and screw misplacement was classified. Potential risk factors for screw misplacement were investigated in three-level mixed-effects logistic regression analysis.
Thirty-four screws (8.9%) were misplaced on the P-side and 37 (9.5%) were misplaced on the O-side; the difference was not statistically significant (P = 0.803). Subclassification analysis revealed minor perforation of 28 screws (7.3%) on the P-side and 32 (8.4%) on the O-side, moderate perforation of 5 screws (1.3%) on the P-side and 4 (1.0%) on the O-side, and severe perforation of 1 screw (0.3%) on each side. Three-level mixed-effects logistic regression analysis identified body mass index as a significant risk factor for screw misplacement on the P-side (odds ratio 1.194, 95% confidence interval 1.066-1.338).
Accuracy of pedicle screw insertion was not significantly different between PPS insertion and conventional open screw insertion in the same patients. Body mass index had a significant influence on the risk of screw misplacement in PPS insertion.
本研究的目的是比较同一患者在单侧开放经椎间孔腰椎椎间融合术（TLIF）中经皮椎弓根螺钉置入（P组）与传统开放螺钉置入（O组）的准确性。我们还试图确定椎弓根螺钉误置的发生率并识别相关危险因素。
本研究是对181例连续接受腰骶部单侧开放TLIF手术患者置入的766枚椎弓根螺钉的前瞻性收集数据进行的回顾性分析。我们的微创TLIF手术是通过单侧开放徒手置入椎弓根螺钉，一侧用于减压，另一侧用于经皮椎弓根螺钉置入。采用这种方法，我们能够比较同一患者中经皮椎弓根螺钉置入与传统开放螺钉置入的准确性。经皮椎弓根螺钉置入383枚，开放方法置入383枚。术后通过重建的计算机断层扫描图像评估螺钉置入的准确性，并对螺钉误置进行分类。在三级混合效应逻辑回归分析中研究螺钉误置的潜在危险因素。
P组有34枚螺钉（8.9%）误置，O组有37枚（9.5%）误置；差异无统计学意义（P = 0.803）。亚分类分析显示，P组有28枚螺钉（7.3%）发生轻微穿孔，O组有32枚（8.4%）；P组有5枚螺钉（1.3%）发生中度穿孔，O组有4枚（1.0%）；每组各有1枚螺钉（0.3%）发生严重穿孔。三级混合效应逻辑回归分析确定体重指数是P组螺钉误置的一个显著危险因素（比值比1.194，95%置信区间1.066 - 1.338）。
同一患者中，经皮椎弓根螺钉置入与传统开放螺钉置入的椎弓根螺钉置入准确性无显著差异。体重指数对经皮椎弓根螺钉置入时螺钉误置的风险有显著影响。
