Neurosurgery Clinic, Ospedale Regionale di Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland.
Orthopaedics Clinic, Ospedale Regionale di Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland.
Spine (Phila Pa 1976). 2021 Apr 15;46(8):530-537. doi: 10.1097/BRS.0000000000003827.
A retrospective analysis of a single-center consecutive series of patients.
To test the hypothesis that using a mobile intraoperative computed tomography in combination with spinal navigation would result in better accuracy of lateral mass and pedicle screws between C3 and T5 levels, compared to cone-beam computed tomography and traditional 2D fluoroscopy.
Use of spinal navigation associated with 3D imaging has been shown to improve accuracy of screw positioning in the cervico-thoracic region. However, use of iCT imaging compared to a cone-beam CT has not been fully investigated in these types of surgical interventions.
We retrospectively analyzed a series of patients who underwent posterior cervico-thoracic fixations using different intraoperative imaging systems in a single hospital. We identified three different groups of patients: Group A, operated under 2D-fluoroscopic guidance without navigation; Group B: O-arm guidance with navigation; Group C: iCT AIRO guidance with navigation. Primary outcome was the rate of accurately placed screws, measured on intra or postoperative CT scan with Neo et al. classification for cervical pedicles screws and Gertzbein et al. for thoracic pedicle screws. Screws in cervical lateral masses were evaluated according to a new classification created by the authors.
Data on 67 patients and 495 screws were available. Overall screw accuracy was 92.8% (95.6% for lateral mass screws, 81.6% for cervical pedicle screws, and 90% for thoracic pedicle screws). Patients operated with iCT AIRO navigation had significantly fewer misplaced screws (2.4%) compared to 2D-fluoroscopic guidance (9.1%) and O-arm navigation (9.7%) (P = 0.0152). Accuracy rate of iCT navigation versus O-arm navigation was significantly higher (P = 0.0042), and there was no statistically significant difference in surgical time between the three Groups (P = 0.5390).
Use of high-quality CT associated with spinal navigation significantly improved accuracy of screw positioning in the cervico-thoracic region.Level of Evidence: 3.
单中心连续系列患者的回顾性分析。
测试以下假设，即在 C3 至 T5 水平，与锥形束 CT 和传统 2D 透视相比，使用术中移动 CT 与脊柱导航相结合，将导致侧块和椎弓根螺钉的准确性更高。
脊柱导航与 3D 成像的结合已被证明可提高颈椎区域螺钉定位的准确性。然而，在这些类型的手术干预中，尚未充分研究 iCT 成像与锥形束 CT 相比的使用情况。
我们回顾性分析了在一家医院中使用不同术中成像系统进行的一系列后颈椎胸椎固定的患者。我们确定了三组患者：A 组，在没有导航的情况下进行 2D 透视引导下手术；B 组：O 臂导航引导下手术；C 组：iCT AIRO 导航引导下手术。主要结果是根据 NeO 等人的颈椎椎弓根螺钉分类和 Gertzbein 等人的胸椎椎弓根螺钉分类，在术中或术后 CT 扫描上测量的准确放置螺钉的比率。颈椎侧块螺钉根据作者创建的新分类进行评估。
共有 67 名患者和 495 枚螺钉的数据可用。总体螺钉准确性为 92.8%（侧块螺钉为 95.6%，颈椎椎弓根螺钉为 81.6%，胸椎椎弓根螺钉为 90%）。与 2D 透视引导（9.1%）和 O 臂导航（9.7%）相比，使用 iCT AIRO 导航的患者螺钉错位的发生率明显较低（2.4%）（P=0.0152）。iCT 导航与 O 臂导航的准确性明显更高（P=0.0042），且三组之间的手术时间无统计学差异（P=0.5390）。
高质量 CT 与脊柱导航的结合使用显著提高了颈椎胸椎区域螺钉定位的准确性。
3 级
