Trauma and Orthopaedic Department, Royal London Hospital, London E1 1FR, UK.
Tomography. 2021 Oct 22;7(4):614-622. doi: 10.3390/tomography7040052.
Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates.
椎弓根螺钉为广泛的适应证提供了极好的固定。然而，它们在颈椎中的应用速度比在胸腰椎中慢，这主要是由于颈椎椎弓根较小，且靠近颈部的神经血管结构。近年来，为了提高颈椎椎弓根螺钉置入的准确性，从而提高安全性，已经开发出了一些技术，包括术中 3D 导航、计算机辅助系统和 3D 模板模具。我们对各种系统的准确性进行了系统评价。在 PubMed 和 Cochrane Library 数据库中搜索了符合条件的论文；发现了 9 篇涉及 1427 枚螺钉的有效论文。荧光透视法的准确性为 80.6%，导航方法的准确性为模板的 91.4%和 96.7%。导航方法明显比荧光透视法更准确，它降低了手术团队的辐射暴露，并且技术的改进正在缩短手术时间。与荧光透视和导航相比，模板的结果显著更好，同时还降低了患者和外科医生的辐射暴露；然而，该技术需要更具侵入性的方法，需要延长术前规划，并需要建立基础设施以允许快速生产和交付。我们肯定导航比其他方法更能提供最准确和最安全的颈椎椎弓根螺钉器械，因为它比荧光透视更准确，而且没有模板的局限性。
