Barsa P, Fröhlich R, Adamík J, Suchomel P
Rozhl Chir. 2020 Spring;99(5):212-218. doi: 10.33699/PIS.2020.99.5.212-218.
The authors analyzed a series of ankylosing spondylitis patients with cervical spine fracture undergoing posterior stabilization using spinal navigation based on intraoperative CT imaging. The purpose of this study was to evaluate the accuracy and safety of navigated posterior stabilization and to analyze the adequacy of this method for treatment of fractures in ankylosed cervical spine.
Prospectively collected clinical data, together with radiological documentation of a series of 8 consecutive patients with 9 cervical spine fracture were included in the analysis. The evaluation of screw insertion accuracy based on postoperative CT imaging, description of instrumentation-related complications and evaluation of morphological and clinical results were the subjects of interest.
Of the 66 implants inserted in all cervical levels and in upper thoracic spine, only 3 screws (4.5%) did not meet the criteria of anatomically correct insertion. Neither screw malposition nor any other intraoperative events were complicated by any neural, vascular or visceral injury. Thus we did not find a reason to change implant position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging in our group of patients was sufficient for reliable trajectory planning and implant insertion in all segments, irrespective of the habitus, positioning method and comorbidities. In addition to stabilization of the fracture, the posterior approach also allows reducing preoperative kyphotic position of the cervical spine. In all patients, we achieved a stable situation with complete bone fusion of the anterior part of the spinal column and lateral masses at one year follow-up.
Spinal navigation based on intraoperative CT imaging has proven to be a reliable and safe method of stabilizing cervical spine with ankylosing spondylitis. The strategy of posterior stabilization seems to be a suitable method providing high primary stability and the conditions for a subsequent high fusion rate.
作者分析了一系列采用基于术中CT成像的脊柱导航进行后路固定的强直性脊柱炎颈椎骨折患者。本研究的目的是评估导航后路固定的准确性和安全性，并分析该方法治疗强直性颈椎骨折的充分性。
前瞻性收集了连续8例患者9处颈椎骨折的临床资料及影像学记录，并纳入分析。基于术后CT成像评估螺钉置入准确性、描述器械相关并发症以及评估形态学和临床结果是研究的重点。
在所有颈椎节段和上胸椎置入的66枚植入物中，只有3枚螺钉（4.5%）不符合解剖学正确置入标准。螺钉位置不当或任何其他术中事件均未并发神经、血管或内脏损伤。因此，我们没有理由在术中或术后改变植入物位置。我们组患者的术中CT成像质量足以在所有节段进行可靠的轨迹规划和植入物置入，无论患者体型、定位方法和合并症如何。除了固定骨折外，后路手术还可减少颈椎术前的后凸位置。在所有患者中，随访一年时均实现了脊柱前路和侧块的完全骨融合，达到了稳定状态。
基于术中CT成像的脊柱导航已被证明是一种可靠、安全的强直性脊柱炎颈椎固定方法。后路固定策略似乎是一种合适的方法，可提供较高的初始稳定性，并为后续的高融合率创造条件。
