Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Spine Deform. 2021 Sep;9(5):1395-1402. doi: 10.1007/s43390-021-00347-x. Epub 2021 Apr 23.
Retrospective cohort, multicenter. A single surgeon study demonstrated that pedicle tract preparation with power tools was associated with lower fluoroscopy times and revision rates compared to manual tools, while maintaining patient safety.
Our purpose was to determine the safety of power-assisted pedicle tract preparation by early adopters of this technology.
Retrospective review comparing patients that underwent posterior spinal fusion by seven pediatric spine surgeons at six institutions between January 1, 2008 and August 31, 2019. The manual pedicle tract preparation used a pedicle awl. Power tract preparation used a flexible 2.0-2.4 mm drill bit, followed by a larger drill bit or a reamer. All screws were inserted with power technique.
In the manual tract preparation group, 9424 screws were placed in 585 cases. In the power tract preparation group, 22,209 screws were placed in 1367 cases. Seven patients (7/1952; 0.36%; 95% CI: 0.14-0.74%) had 11 mal-positioned screws (11/31,633; 0.03%; 95% CI: 0.017-0.062%). Seven screws (7/9424; 0.07%; 95% CI: 0.030-0.15%) were in the manual cohort and four (4/22,209; 0.02%; 95% CI: 0.0049-0.046%) were in the power cohort. There were significantly more revisions per screw in the manual cohort (p = 0.02). However, there were not significantly more revisions per patient in the manual cohort (manual: 0.5%, 3/585 vs. power: 0.3%, 4/1,367; p = 0.43). Of these seven, three patients (3/585; 0.5%; 95% CI: 0.1-1.5%) experienced neurologic injury or neuro-monitoring changes requiring screw removal in the manual cohort, and 1 patient (1/1,367, 0.07%; 95% CI: 0.002-0.4%) in the power cohort (p = 0.08). Three additional patients underwent revision in the power cohort: 1 for an asymptomatic lateral breech, 1 for a spinal headache/medial breech that developed after an MVA, and 1 for an iliac vein injury during pedicle tract preparation.
This is the first multi-center study examining power pedicle preparation. Overall, 99.9% of pedicle screws placed with power pedicle preparation did not have complications or revision. Equivalent patient safety was demonstrated compared to manual technique.
III.
回顾性队列，多中心。一位外科医生的研究表明，与手动工具相比，使用动力工具进行椎弓根通道准备与较低的透视时间和翻修率相关，同时保持患者安全。
我们的目的是确定早期采用该技术的患者使用动力辅助椎弓根通道准备的安全性。
回顾性比较了 2008 年 1 月 1 日至 2019 年 8 月 31 日期间，7 位儿科脊柱外科医生在 6 家机构对接受后路脊柱融合术的患者。手动椎弓根通道准备使用椎弓根钻。动力通道准备使用 2.0-2.4mm 的柔性钻头，然后使用较大的钻头或铰刀。所有螺钉均使用动力技术插入。
在手动通道准备组中，585 例患者中放置了 9424 枚螺钉。在动力通道准备组中，1367 例患者中放置了 22209 枚螺钉。7 名患者（7/1952；0.36%；95%CI：0.14-0.74%）有 11 枚螺钉位置不当（11/31633；0.03%；95%CI：0.017-0.062%）。7 枚螺钉（7/9424；0.07%；95%CI：0.030-0.15%）位于手动组，4 枚螺钉（4/22209；0.02%；95%CI：0.0049-0.046%）位于动力组。手动组每枚螺钉的翻修率明显更高（p=0.02）。然而，手动组的每位患者的翻修率没有明显更高（手动：0.5%，3/585 与动力：0.3%，4/1367；p=0.43）。在这 7 例中，3 例（3/585；0.5%；95%CI：0.1-1.5%）患者在手动组出现神经损伤或神经监测变化需要去除螺钉，1 例（1/1367，0.07%；95%CI：0.002-0.4%）患者在动力组（p=0.08）。动力组另外 3 例患者进行了翻修：1 例为无症状外侧偏离，1 例为 MVA 后出现的脊柱头痛/内侧偏离，1 例为椎弓根通道准备时髂静脉损伤。
这是第一项多中心研究，检查了动力椎弓根准备。总体而言，使用动力椎弓根准备放置的 99.9%的椎弓根螺钉没有并发症或翻修。与手动技术相比，表现出同等的患者安全性。
III。
