Pojskić Mirza, Bopp Miriam, Saß Benjamin, Kirschbaum Andreas, Nimsky Christopher, Carl Barbara
Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany.
Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany.
Brain Sci. 2021 May 15;11(5):646. doi: 10.3390/brainsci11050646.
Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.
脊柱外侧入路因能够实现脊柱的微创入路、减少失血、缩短手术时间以及减轻术后疼痛而越来越受欢迎。本研究的目的是分析术中计算机断层扫描（CT）结合导航以及增强现实技术在辅助脊柱外侧入路中的应用。我们前瞻性地分析了2016年9月至2021年1月期间所有采用脊柱外侧入路手术的患者，术中使用32层移动CT扫描仪进行CT扫描，用于自动导航注册。16例患者接受了胸腰椎脊柱外侧入路手术并使用术中CT结合导航，中位年龄为64.3岁。手术指征包括椎间盘突出症（6例）、肿瘤（7例）、胸腰椎骨折后不稳定（2例）以及脊椎椎间盘炎（1例）。使用术中CT进行自动注册，精度很高（目标注册误差：0.84±0.10毫米）。注册CT扫描的有效辐射剂量为6.16±3.91毫希沃特。7例患者进行了对照术中CT扫描以进行切除和植入物控制，有效辐射剂量为4.51±2.48毫希沃特。11例患者使用增强现实（AR）技术辅助手术，通过可视化肿瘤轮廓、椎弓根螺钉、突出的椎间盘以及周围结构。16例患者中，6例进行了椎体次全切除术并植入可扩张椎间融合器，1例患者使用斜外侧腰椎椎间融合（XLIF）技术进行了椎间盘切除术。1例患者出现围手术期并发症。1例患者术后早期因严重心肺功能衰竭死亡。10例患者病情改善，5例患者在3个月随访时神经功能状态未改变。术中计算机断层扫描结合导航有助于脊柱外侧入路在多种手术指征中的应用，包括融合手术、肿瘤切除以及椎间盘突出症手术。
