Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Switzerland.
Spine J. 2022 Jul;22(7):1160-1168. doi: 10.1016/j.spinee.2022.01.002. Epub 2022 Jan 10.
Patient-specific instruments (PSI) have been well established in spine surgery for pedicle screw placement. However, its utility in spinal decompression surgery is yet to be investigated.
The purpose of this study was to investigate the feasibility and utility of PSI in spinal decompression surgery compared with conventional freehand (FH) technique for both expert and novice surgeons.
Human cadaver study.
Thirty-two midline decompressions were performed on 4 fresh-frozen human cadavers. An expert spine surgeon and an orthopedic resident (novice) each performed 8 FH and 8 PSI-guided decompressions. Surgical time for each decompression method was measured. Postoperative decompression area, cranial decompression extent in relation to the intervertebral disc, and lateral recess bony overhang were measured on postoperative CT-scans. In the PSI-group, the decompression area and osteotomy accuracy were evaluated.
The surgical time was similar in both techniques, with 07:25 min (PSI) versus 06:53 min (FH) for the expert surgeon and 12:36 min (PSI) vs. 11:54 (FH) for the novice surgeon. The postoperative cranial decompression extent and the lateral recess bony overhang did not differ between both techniques and surgeons. Further, the postoperative decompression area was significantly larger with the PSI than with the FH for the novice surgeon (477 vs. 305 mm; p=.01), but no significant difference was found between both techniques for the expert surgeon. The execution of the decompression differed from the preoperative plan in the decompression area by 5%, and the osteotomy planes had an accuracy of 1-3 mm.
PSI-guided decompression is feasible and accurate with similar procedure time to the standard FH technique in a cadaver model, which warrants further investigation in vivo. In comparison to the FH technique, a more extensive decompression was achieved with PSI in the novice surgeon's hands in this study.
The PSI-guided spinal decompression technique may be a useful alternative to FH decompression in certain situations. A special potential of the PSI technique could lie in the technical aid for novice surgeons and in situations with unconventional anatomy or pathologies such as deformity or tumor. This study serves as a starting point toward PSI-guided spinal decompression, but further in vivo investigations are necessary.
患者特异性器械（PSI）在脊柱外科中已广泛应用于椎弓根螺钉放置。然而，其在脊柱减压手术中的应用尚未得到研究。
本研究旨在比较专家和新手外科医生使用 PSI 和传统徒手（FH）技术进行脊柱减压手术的可行性和实用性。
人体尸体研究。
在 4 个新鲜冷冻人体尸体上进行了 32 次中线减压。一名脊柱外科专家和一名骨科住院医师（新手）分别进行了 8 次 FH 和 8 次 PSI 引导下的减压。测量每种减压方法的手术时间。术后 CT 扫描测量术后减压面积、椎间盘上方的颅侧减压范围以及侧隐窝骨性突出。在 PSI 组中，评估减压面积和截骨准确性。
两种技术的手术时间相似，专家外科医生分别为 07:25 分钟（PSI）和 06:53 分钟（FH），新手外科医生分别为 12:36 分钟（PSI）和 11:54 分钟（FH）。两种技术和外科医生的术后颅侧减压范围和侧隐窝骨性突出均无差异。此外，与 FH 相比，新手外科医生使用 PSI 进行减压后的减压面积明显更大（477 毫米 vs. 305 毫米；p=.01），但专家外科医生之间无显著差异。在尸体模型中，PSI 引导的减压在手术时间上与标准 FH 技术相似，且具有相似的可行性和准确性，但需要进一步的体内研究。与 FH 技术相比，在本研究中，新手外科医生使用 PSI 可实现更广泛的减压。
PSI 引导的减压在尸体模型中具有与标准 FH 技术相似的手术时间，且可行和准确，这为进一步的体内研究提供了依据。与 FH 技术相比，PSI 技术在某些情况下可能是一种有用的 FH 减压替代方法。PSI 技术的一个特殊潜力可能在于为新手外科医生提供技术辅助，以及在非常规解剖结构或病变（如畸形或肿瘤）情况下提供帮助。本研究为 PSI 引导的脊柱减压提供了一个起点，但还需要进一步的体内研究。
