Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
BMC Surg. 2021 Mar 20;21(1):149. doi: 10.1186/s12893-021-01148-9.
BACKGROUND: Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved. METHODS: This retrospective study explored the effects of electromagnetic navigation on improving Endo-TLIF with percutaneous pedicle screw fixation. Clinical information from 42 patients who had received Endo-TLIF with percutaneous pedicle screw fixation from May 2019 to November 2020 was analyzed retrospectively. The procedures were assisted under electromagnetic navigation. The rate of adjustment for guide wires, frequency of X-ray exposure, operative time, accuracy of pedicle screw location, and clinical outcomes were recorded. RESULTS: The mean follow-up for 42 patients was 11.9 ± 3.1 months. The mean age of the patients was 56.1 ± 9.26 years, with a female/male ratio of 25:17. According to postoperative CT scans and 3D reconstructions, the excellent and good rate of pedicle screws was 96.4%. The rate of adjustment for guide wires under the assistance of electromagnetic navigation was 1.78%, and the frequency of X-ray exposure was 8.27 ± 1.83. The operative time was 167.25 ± 28.16 min, including the duration of guide wire insertion (14.63 ± 5.45 min) and duration of decompression and cage placement (75.43 ± 13.97 min). The duration of hospitalization after operation was 2.59 ± 1.16 days. The preoperative VAS score was 7.51 ± 1.91, and the preoperative ODI was 82.42 ± 8.7%. At the last follow-up, the VAS score was 2.09 ± 0.59, and the ODI was 11.09 ± 3.2%. There were statistically significant improvements in the VAS score and ODI in all patients at the follow-up (p < 0.05). CONCLUSIONS: Electromagnetic navigation can provide accurate positioning and guidance in real time, which improves the surgical efficiency of percutaneous pedicle screw placement and endoscopic decompression in Endo-TLIF with reduced radiation exposures.
背景：经皮椎弓根螺钉固定的单通道全内镜经椎间孔腰椎体间融合术（Endo-TLIF）是治疗腰椎滑脱症的一种有前途的微创方法。然而，X 射线的反复辐射暴露和陡峭的学习曲线仍有待改善。
方法：本回顾性研究探讨了电磁导航对经皮椎弓根螺钉固定的 Endo-TLIF 的影响。分析了 2019 年 5 月至 2020 年 11 月接受经皮椎弓根螺钉固定的 Endo-TLIF 的 42 例患者的临床资料。在电磁导航辅助下进行手术。记录导丝调整率、X 射线暴露频率、手术时间、椎弓根螺钉定位准确性和临床结果。
结果：42 例患者的平均随访时间为 11.9±3.1 个月。患者的平均年龄为 56.1±9.26 岁，男女比例为 25:17。根据术后 CT 扫描和 3D 重建，椎弓根螺钉的优秀和良好率为 96.4%。在电磁导航辅助下，导丝调整率为 1.78%，X 射线暴露频率为 8.27±1.83。手术时间为 167.25±28.16 分钟，包括导丝插入时间（14.63±5.45 分钟）和减压、放置椎间融合器时间（75.43±13.97 分钟）。术后住院时间为 2.59±1.16 天。术前 VAS 评分为 7.51±1.91，ODI 评分为 82.42±8.7%。末次随访时，VAS 评分为 2.09±0.59，ODI 评分为 11.09±3.2%。所有患者随访时 VAS 评分和 ODI 均有统计学显著改善（p<0.05）。
结论：电磁导航可实时提供准确的定位和引导，提高经皮椎弓根螺钉置入和内镜减压的手术效率，并减少辐射暴露。
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