Domino Joseph S, Smith Kyle A, Arnold Paul M
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS.
Semmes-Murphey Clinic, Memphis, TN.
Clin Spine Surg. 2021 Mar 1;34(2):E80-E85. doi: 10.1097/BSD.0000000000001054.
Retrospective review of prospectively collected single-institution database.
To analyze the clinical and radiographic outcomes of posterior thoracolumbar fusions using intraoperative computed tomography (CT)-guidance and stereotactic navigation in thoracolumbar spinal trauma.
Pedicle screw instrumentation is utilized for stabilization in thoracolumbar fusions. Suboptimal placement may lead to neurovascular complications, pseudarthrosis, postoperative pain, and the need for revision surgery. Image-guided spinal surgery is commonly used to improve accuracy, particularly for complex anatomy such as encountered with traumatic fractures.
We retrospectively identified 58 patients undergoing posterior thoracolumbar fusions using intraoperative CT and stereotactic navigation for traumatic fractures from 2010 to 2017 at a single institution. Pedicle screw accuracy, realignment, clinical outcomes, and ease of use were retrospectively reviewed. Accuracy was assessed on postplacement or postoperative CT. Breach grades included: grade 1 (<2 mm), grade 2 (2-4 mm), and grade 3 (>4 mm).
A total of 58 patients were identified having undergone 58 operations, which involved placement of 519 pedicle screws. Traumatic fracture patterns and levels of injury were varied. Accurate pedicle screw placement was found in 95.8% and was stable over time. Breach included: grade 1 in 19 screws, grade 2 in 2 screws, and grade 3 in 1 screw. No neurovascular complications were noted. No revision surgery was performed for misplacement. A subgroup of 6 ankylosing spondylitis patients were identified having undergone 6 operations with 63 pedicle screws. Accurate pedicle screw placement was found in 93.7%.
Intraoperative CT-guidance and stereotactic navigation can overcome the difficulty associated with thoracolumbar trauma resulting in complex anatomy with malalignment and unpredictable trajectories. Intraoperative CT can be used with stereotactic guidance or for intraoperative verification of free-hand screw placement with repositioning as needed. CT-guidance maintains the benefit of reduced fluoroscopic exposure while improving accuracy of instrumentation and reducing reoperation for screw malposition.
对前瞻性收集的单机构数据库进行回顾性分析。
分析在胸腰椎脊柱创伤中使用术中计算机断层扫描（CT）引导和立体定向导航进行胸腰椎后路融合术的临床和影像学结果。
椎弓根螺钉内固定用于胸腰椎融合术的稳定。放置不当可能导致神经血管并发症、假关节形成、术后疼痛以及翻修手术的需要。影像引导脊柱手术常用于提高准确性，特别是对于创伤性骨折等复杂解剖结构。
我们回顾性确定了2010年至2017年在单机构接受术中CT和立体定向导航进行创伤性骨折胸腰椎后路融合术的58例患者。回顾性分析椎弓根螺钉的准确性、复位情况、临床结果和易用性。准确性在放置后或术后CT上进行评估。突破分级包括：1级（<2毫米）、2级（2 - 4毫米）和3级（>4毫米）。
共确定58例患者接受了58次手术，其中包括519枚椎弓根螺钉的置入。创伤性骨折类型和损伤节段各不相同。95.8%的椎弓根螺钉放置准确，且随时间保持稳定。突破情况包括：19枚螺钉为1级，2枚螺钉为2级，1枚螺钉为3级。未发现神经血管并发症。未因放置不当进行翻修手术。确定了6例强直性脊柱炎患者的亚组，他们接受了6次手术，置入63枚椎弓根螺钉。93.7%的椎弓根螺钉放置准确。
术中CT引导和立体定向导航可克服与胸腰椎创伤相关的困难，胸腰椎创伤会导致解剖结构复杂、排列不齐和轨迹不可预测。术中CT可与立体定向引导一起使用，或用于术中徒手螺钉置入的验证，并根据需要重新定位。CT引导在减少透视暴露的同时，保持了提高内固定准确性和减少螺钉位置不当导致的再次手术的益处。
