TrackX Technology, LLC, Chapel Hill, USA.
Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA.
World Neurosurg. 2021 Aug;152:e101-e111. doi: 10.1016/j.wneu.2021.05.058. Epub 2021 May 24.
Minimally invasive surgical techniques have resulted in improved patient outcomes. One drawback has been the increased reliance on fluoroscopy and subsequent exposure to ionizing radiation. We have previously shown the efficacy of a novel instrument tracking system in cadaveric and preliminary clinical studies for commonplace orthopedic and spine procedures. In the present study, we examined the radiation and operative time using a novel instrument tracking system compared with standard C-arm fluoroscopy for patients undergoing minimally invasive lumbar fusion.
The radiation emitted, number of radiographs taken, and time required to complete 2 tasks were recorded between the instrument tracking systems and conventional C-arm fluoroscopy. The studied tasks included placement of the initial dilator through Kambin's triangle during percutaneous lumbar interbody fusion and placement of pedicle screws during both percutaneous lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion with or without instrument tracking.
A total of 23 patients were included in the analysis encompassing 31 total levels. For the task of placing the initial dilator into Kambin's triangle, an average of 4.21 minutes (2.4 vs. 6.6 minutes; P = 0.002), 15 fluoroscopic images (5.4 vs. 20.5; P = 0.002), and 8.14 mGy (3.3 vs. 11.4; P = 0.011) were saved by instrument tracking. For pedicle screw insertion, an average of 5.69 minutes (3.97 vs. 9.67; P < 0.001), 14 radiographs (6.53 vs. 20.62; P < 0.001), and 7.89 mGy (2.98 vs. 10.87 mGy; P < 0.001) were saved per screw insertion.
Instrument tracking, when used for minimally invasive lumbar fusion, leads to significant reductions in radiation and operative time compared with conventional fluoroscopy.
微创外科技术已改善了患者的预后。缺点之一是对透视的依赖增加，随之而来的是电离辐射暴露增加。我们之前在尸体和初步临床研究中已经证明了一种新型仪器跟踪系统在常见的骨科和脊柱手术中的功效。在本研究中，我们检查了使用新型仪器跟踪系统与标准 C 臂透视在接受微创腰椎融合术的患者中的辐射和手术时间。
在仪器跟踪系统和传统 C 臂透视之间记录完成 2 项任务所需的辐射量、拍摄的 X 光片数量和完成时间。研究的任务包括经皮腰椎椎间融合术中穿过 Kambin 三角放置初始扩张器，以及经皮腰椎椎间融合术和微创经椎间孔腰椎椎间融合术（有或没有仪器跟踪）中放置椎弓根螺钉。
共有 23 例患者纳入分析，共 31 个节段。在将初始扩张器放置于 Kambin 三角的任务中，仪器跟踪平均节省了 4.21 分钟（2.4 分钟对 6.6 分钟；P=0.002）、15 张 X 光片（5.4 张对 20.5 张；P=0.002）和 8.14 mGy（3.3 对 11.4 mGy；P=0.011）。对于椎弓根螺钉插入，平均节省了 5.69 分钟（3.97 分钟对 9.67 分钟；P<0.001）、14 张 X 光片（6.53 张对 20.62 张；P<0.001）和 7.89 mGy（2.98 对 10.87 mGy；P<0.001）。
与传统透视相比，在微创腰椎融合术中使用仪器跟踪可显著减少辐射和手术时间。
