CT 透视配准与扫描与计划配准在腰椎椎弓根螺钉机器人辅助植入中的比较。

CT-to-fluoroscopy registration versus scan-and-plan registration for robot-assisted insertion of lumbar pedicle screws.

机构信息

1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo.

2Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York.

出版信息

Neurosurg Focus. 2022 Jan;52(1):E8. doi: 10.3171/2021.10.FOCUS21506.

DOI:10.3171/2021.10.FOCUS21506

PMID:34973678

Abstract

OBJECTIVE

Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods.

METHODS

A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports.

RESULTS

Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3).

CONCLUSIONS

Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

摘要

目的

脊柱外科医生通常在腰椎融合术后进行椎弓根螺钉固定以进行稳定。随着导航技术的出现，椎弓根螺钉插入的准确性得到了提高。机器人引导技术通过两种截然不同的影像学注册方法（扫描和计划方法以及 CT 与透视方法）彻底改变了椎弓根螺钉的放置方式。在这项研究中，作者旨在比较这些方法的准确性和安全性。

方法

在两个中心进行了回顾性图表审查，以获取连续接受机器人辅助腰椎椎弓根螺钉放置的患者的手术数据。在所有情况下都使用了最新的机器人平台（Mazor X 机器人系统）。一个中心使用扫描和计划注册方法，另一个中心使用 CT 与透视进行注册。螺钉的准确性通过应用 Gertzbein-Robbins 量表来确定。从放射学报告中收集了透视曝光时间。

结果

总体而言，268 例患者接受了椎弓根螺钉插入术，其中 126 例采用扫描和计划注册，142 例采用 CT 与透视注册。在扫描和计划组中，在 266 个脊柱水平上插入了 450 个螺钉（平均每个水平 1.7 ± 1.1 个螺钉），其中 446 个（99.1％）螺钉被归类为 Gertzbein-Robbins 分级 A（在椎弓根内）和 4 个（0.9％）为 B 级（偏差<2mm）。在 CT 与透视组中，在 280 个腰椎脊柱水平上插入了 574 个螺钉（平均每个水平 2.05 ± 1.7 个螺钉），其中 563 个（98.1％）为 A 级螺钉，11 个（1.9％）为 B 级（p = 0.17）。扫描和计划组中每个螺钉的透视曝光量明显少于 CT 与透视组（12 ± 13 秒与 11.1 ± 7 秒，p = 0.3）。