Goel-Harms 经皮寰枢椎螺钉内固定术中的计算机断层扫描：临床疗效分析及螺钉放置准确性的新分类。

Intraoperative Computed Tomography for C1-C2 Stabilization by Goel-Harms: Analysis of Clinical Efficacy and a Novel Classification of Screw Placement Accuracy.

机构信息

Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.

出版信息

World Neurosurg. 2022 Feb;158:e19-e37. doi: 10.1016/j.wneu.2021.10.063. Epub 2021 Oct 12.

DOI:10.1016/j.wneu.2021.10.063

PMID:34648982

Abstract

BACKGROUND

The introduction of intraoperative computed tomography (iCT) could improve the surgical results of C1-C2 stabilization by Goel-Harms, especially in patients with complex deformities. This study aims to investigate the impact of iCT on the accuracy of C1-C2 screw positioning and to develop a score based on multiparametric analysis of imaging data (Cervical Screw Placement Accuracy score [CSPAs]).

METHODS

Twenty-one patients were retrospectively evaluated. The data obtained with the use of an iCT were compared with the incidence of cases of malpositioning in the literature. Multiparametric imaging criteria were developed: the 82 screw positions were evaluated using the CSPA criteria and 2 additional variables. The CSPAs was obtained from the aggregation of the CSPAs criteria: optimal (CSPAs ≥8), suboptimal (CSPAs = 6-7), malpositioned (CSPAs ≤5).

RESULTS

The average incidence of malpositioning in C1-C2 arthrodesis decreased from 13% without iCT to 1.2% with the aid of iCT, considering a monoparametric value. The CSPAs analysis shows a greater discretion and higher number of well-defined categories of the accuracy of C1-C2 screw position: optimal, 80.3%; suboptimal, 17.1%; and malposition, 2.6%. A correlation was observed between the accuracy of the positioning of both right and left screws in C2. Furthermore, the anatomic site of C2 screws was found to be a predictor of cortical invasion.

CONCLUSIONS

The results suggest that the introduction of the iCT is associated with a consistent improvement of the accuracy in the positioning of the screws. A multiparametric score (CSPAs) could improve the assessment of screw placement.

摘要

背景

术中计算机断层扫描（iCT）的引入可以提高 Goel-Harms 法 C1-C2 稳定术的手术效果，特别是在复杂畸形患者中。本研究旨在探讨 iCT 对 C1-C2 螺钉定位准确性的影响，并基于影像学数据的多参数分析（颈椎螺钉放置准确性评分 [CSPAs]）开发一种评分方法。

方法

回顾性评估了 21 例患者。比较了使用 iCT 获得的数据与文献中出现的定位不良病例发生率。制定了多参数成像标准：使用 CSPA 标准和 2 个附加变量评估 82 个螺钉位置。CSPAs 通过聚合 CSPAs 标准获得：最佳（CSPAs≥8）、次优（CSPAs=6-7）、错位（CSPAs≤5）。

结果

在考虑单参数值的情况下，使用 iCT 辅助治疗后，C1-C2 融合术的螺钉定位不良发生率从无 iCT 时的 13%降低到 1.2%。CSPAs 分析显示，C1-C2 螺钉位置准确性的分类更具辨别力，定义更明确：最佳 80.3%，次优 17.1%，错位 2.6%。还观察到 C2 双侧螺钉定位准确性之间存在相关性。此外，C2 螺钉的解剖位置被发现是皮质侵犯的预测因素。