Banat Mohammed, Wach Johannes, Salemdawod Abdallah, Domurath Lisa, Scorzin Jasmin, Vatter Hartmut
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Front Surg. 2021 Jul 14;8:692189. doi: 10.3389/fsurg.2021.692189. eCollection 2021.
Dorsal instrumentation of the spine is an established treatment option for a range of spinal pathologies. Intraoperative fluoroscopy connected with navigation minimize the risk of incorrect screws placement. In several cases, post-operative CT scans are needed to verify possible mismatches. In this study, we evaluated the efficacy of 3D intraoperative fluoroscopy as compared to post-operative CT and the need of post-operative CT. We conducted a prospective single-center cohort study, 94 patients were included. The screws were implanted using 3D rotation with C-arm and navigation system. The definitive position of the screws was verified by a post-operative CT scan. Finally, we compared the discrepance between intraoperative imaging and post-operative CT scan using Rampersaud-grade (A-D). 607 screws in 94 patients were included. Some 3% of the screws had to be replaced immediately intraoperative due to inadequate position with lateral or medial trajectory. An A-score was achieved for 85.5% of the 3D controlled screws and 87% of the post-operative CT. A B-score was found in 11.5% of either groups. In the 3D group a C-score was achieved for 2.5% and in the CT group for 0.8%. A D-score was found in 0.5% of the screws in both groups, = 0.45. Only a mismatch of 3% could be detected for the intraoperative and post-operative imaging results. Our study data shows that the placement of screws using the 3D rotation and navigation tool is safe and accurate. There were no relevant mismatches between intraoperative images and the post-operative CT.
脊柱后路内固定术是治疗一系列脊柱疾病的既定治疗选择。术中透视与导航相结合可将螺钉植入位置错误的风险降至最低。在一些情况下，需要术后CT扫描来验证可能存在的不匹配情况。在本研究中，我们评估了术中三维透视与术后CT相比的有效性以及术后CT的必要性。我们进行了一项前瞻性单中心队列研究，纳入了94例患者。使用C形臂三维旋转和导航系统植入螺钉。通过术后CT扫描验证螺钉的最终位置。最后，我们使用兰珀索德分级（A - D）比较术中成像与术后CT扫描之间的差异。94例患者共植入607枚螺钉。约3%的螺钉因外侧或内侧轨迹位置不当而在术中立即更换。三维控制螺钉中有85.5%以及术后CT中有87%获得了A评分。两组中均有11.5%获得了B评分。三维组中有2.5%获得了C评分，CT组中有0.8%获得了C评分。两组中均有0.5%的螺钉获得了D评分，P = 0.45。术中与术后成像结果之间仅能检测到3%的不匹配情况。我们的研究数据表明，使用三维旋转和导航工具植入螺钉是安全且准确的。术中图像与术后CT之间不存在相关的不匹配情况。
