Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Université de Paris, Paris, France.
Int Orthop. 2022 Feb;46(2):321-329. doi: 10.1007/s00264-021-05276-y. Epub 2022 Jan 7.
Intra-operative image acquisition coupled with navigation aims to increase screw placement accuracy, and it is particularly helpful in complex spinal procedures. The aim of this study is to analyze the accuracy and reliability of posterior atlanto-axial fixation using spinal navigation combined with intra-operative 3D isocentric C-arm.
We retrospectively reviewed all patients presenting with C1-C2 instability and treated by posterior atlanto-axial fixation in our center between December 2016 and September 2018. Screw positioning was guided by intra-operative navigation, registered with surface matching procedure on a previously obtained CT scan and controlled by intra-operative 3D isocentric C-arm. Age, sex, pre- and post-operative neurological status, duration of surgery, presence/absence of vertebral artery injury, and screw placement were retrospectively collected from patients' records. All patients underwent clinical and radiological follow-up at three months after surgery. Radiological assessment of screw positioning was performed by an independent radiologist using the Gertzbein and Robbins grading.
N = 11 (7F, 4 M) consecutive patients were included, with a mean age of 72 years (range from 51 to 85). N = 44 navigated screws were inserted and controlled with intra-operative 3D fluoroscopy at the end of the procedure. An acceptable screw positioning (Gertzbein-Robbins grade A and B) was obtained in all cases (100%). No vertebral artery injury was observed. Mean operating time was 123 minutes. At three months, no screw loosening or displacement was observed.
In our experience, spinal navigation coupled with intra-operative 3D fluoroscopy proved to be reliable and safe for C1-C2 screw placement.
术中图像采集与导航旨在提高螺钉放置的准确性，尤其有助于复杂脊柱手术。本研究旨在分析使用脊柱导航结合术中三维等中心 C 臂对寰枢后固定的准确性和可靠性。
我们回顾性分析了 2016 年 12 月至 2018 年 9 月期间在我院因寰枢椎不稳而行后路寰枢椎固定术的所有患者。术中导航引导螺钉定位，在预先获得的 CT 扫描上进行表面匹配注册，并通过术中三维等中心 C 臂进行控制。从患者病历中回顾性收集年龄、性别、术前和术后神经状态、手术持续时间、椎动脉损伤情况和螺钉放置情况。所有患者术后均行临床和影像学随访，随访时间为术后 3 个月。螺钉定位的影像学评估由一位独立的放射科医生使用 Gertzbein 和 Robbins 分级法进行。
连续纳入 11 例（7 例女性，4 例男性）患者，平均年龄 72 岁（51 岁至 85 岁）。导航引导下共置入 44 枚螺钉，术中三维透视检查确认最终位置。所有病例均获得可接受的螺钉定位（Gertzbein-Robbins 分级 A 和 B）（100%）。未观察到椎动脉损伤。平均手术时间为 123 分钟。术后 3 个月，未观察到螺钉松动或移位。
在我们的经验中，脊柱导航结合术中三维透视对 C1-C2 螺钉的放置是可靠和安全的。
