Hiyama Akihiko, Katoh Hiroyuki, Sakai Daisuke, Sato Masato, Tanaka Masahiro, Watanabe Masahiko
Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan.
Asian Spine J. 2022 Feb;16(1):20-27. doi: 10.31616/asj.2020.0526. Epub 2021 May 4.
Retrospective study.
The purpose of this study was to compare the accuracy of percutaneous pedicle screw (PPS) placement between prone and lateral decubitus positions during lateral lumbar interbody fusion (LLIF) and to evaluate the tendency of PPS positioning based on simple computed tomography measurements with patients in the lateral decubitus position.
There is insufficient information in the literature regarding the accuracy of inserting a PPS using fluoroscopy in patients in the lateral decubitus position.
We included 62 patients who underwent combined LLIF surgery and PPS fixation for degenerative lumbar spondylolisthesis with spinal canal stenosis. We compared the patient demographics and the accuracy of fluoroscopy-guided PPS placement between two groups: patients who remained in the lateral decubitus position for the pedicle screw fixation (single-position surgery [SPS] group) and those who were turned to the prone position (dual-position surgery [DPS] group).
There were 40 patients in the DPS group and 22 in the SPS group. Of the 292 PPSs, only 12 were misplaced. In other words, 280/292 screws (95.9%) were placed correctly in the pedicle's cortical shell (grade 0). PPS insertion did not cause neurological, vascular, or visceral injuries in either group. The breach rates for the DPS and SPS groups were 4.1% (grade 1, 5 screws; grade 2, 3 screws; grade 3, 0 screw) and 4.1% (grade 1, 2 screws; grade 2, 2 screws; grade 3, 0 screw), respectively. Although there were no statistically significant differences, the downside PPS had more screw malpositioning than the upside PPS.
We found that PPS insertion with the patient in the decubitus position under fluoroscopic guidance might be as safe and reliable a technique as PPS insertion in the prone position, with a misplacement rate similar to that previously published.
回顾性研究。
本研究旨在比较腰椎侧方椎间融合术（LLIF）期间俯卧位与侧卧位经皮椎弓根螺钉（PPS）置入的准确性，并基于侧卧位患者的简单计算机断层扫描测量评估PPS定位倾向。
关于在侧卧位患者中使用荧光透视法插入PPS的准确性，文献中的信息不足。
我们纳入了62例行LLIF手术联合PPS固定治疗退行性腰椎滑脱伴椎管狭窄的患者。我们比较了两组患者的人口统计学特征以及荧光透视引导下PPS置入的准确性：在椎弓根螺钉固定时保持侧卧位的患者（单体位手术[SPS]组）和转为俯卧位的患者（双体位手术[DPS]组）。
DPS组有40例患者，SPS组有22例患者。在292枚PPS中，只有12枚位置不当。换句话说，280/292枚螺钉（95.9%）正确置入椎弓根皮质骨壳内（0级）。两组中PPS置入均未导致神经、血管或内脏损伤。DPS组和SPS组的突破率分别为4.1%（I级，5枚螺钉；II级，3枚螺钉；III级，0枚螺钉）和4.1%（I级，2枚螺钉；II级，2枚螺钉；III级，0枚螺钉）。虽然没有统计学上的显著差异，但下位PPS的螺钉位置不当比上位PPS更多。
我们发现，在荧光透视引导下患者处于卧位时进行PPS置入可能与俯卧位PPS置入一样安全可靠，错位率与先前发表的相似。
