Marzouk Martin Mohammed, Afghanyar Yama, Marzouk Mark Mahmoud, Boussouf Sarah Halima, Hartung Philipp, Richter Marcus
Spine Center, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Hesse, Germany.
, Alt Oberliederbach 1, 65835, Liederbach, Hesse, Germany.
Eur Spine J. 2022 Mar;31(3):685-692. doi: 10.1007/s00586-021-07082-x. Epub 2022 Jan 7.
This retrospective matched case-control study was conducted to compare two CT based surgery techniques for navigated screw placement in spinal surgery, whether a reduction of radiation exposure and surgery time could be achieved.
We matched cases treated with an intraoperative CT (iCT), regarding the type and number of implants, with cases treated with a preoperative CT (pCT) of one main surgeon. Outcome measures were radiation exposure due to intraoperative control x-rays, radiation exposure due to CT images, and the duration of surgery.
The required radiation exposure could be significantly reduced in the iCT group. For the intraoperative control X-rays by 69% (median (MED) 88.50/standard deviation (SD) 107.84 and MED 286.00/SD 485.04 for iCT and pCT respectively-in Gycm; p < 0.001) and for the CT examinations by 25% (MED 317.00/SD 158.62 and MED 424.50/SD 225.04 for iCT and pCT respectively-in mGycm; p < 0.001) with no significant change in surgery time. The correlation between the number of segments fused and the necessary surgery time decreased significantly for the iCT group (Pearson product-moment-correlation: r = 0.569 and r = 0.804 for iCT and pCT respectively; p < 0.05).
The results show that spinal navigation using an intraoperative CT with automatic registration compared to a preoperative CT and intraoperative manual surface registration, allows a significant reduction of radiation exposure, without prolonged surgery time. A significant benefit regarding cut-to-suture-time can be gained with surgeries of a larger scale.
本回顾性配对病例对照研究旨在比较脊柱手术中两种基于CT的导航螺钉置入手术技术，是否能够减少辐射暴露和手术时间。
我们将接受术中CT（iCT）治疗的病例，根据植入物的类型和数量，与同一位主刀医生进行的术前CT（pCT）治疗的病例进行配对。观察指标为术中对照X线导致的辐射暴露、CT图像导致的辐射暴露以及手术时长。
iCT组所需的辐射暴露可显著降低。术中对照X线降低了69%（iCT组和pCT组的中位数（MED）分别为88.50/标准差（SD）107.84和286.00/SD 485.04，单位为Gycm；p<0.001），CT检查降低了25%（iCT组和pCT组的MED分别为317.00/SD 158.62和424.50/SD 225.04，单位为mGycm；p<0.001），而手术时间无显著变化。iCT组融合节段数量与必要手术时间之间的相关性显著降低（Pearson积矩相关性：iCT组和pCT组的r分别为0.569和0.804；p<0.05）。
结果表明，与术前CT和术中手动表面配准相比，使用自动配准的术中CT进行脊柱导航可显著减少辐射暴露，且不会延长手术时间。对于更大规模的手术，在切开至缝合时间方面可获得显著益处。
