Yeretsian Tiffany, Lai Carolyn, Guha Daipayan, Ramjist Joel, Yang Victor X D
School of Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada.
AME Case Rep. 2022 Jan 25;6:9. doi: 10.21037/acr-21-62. eCollection 2022.
Computer-assistance for pedicle screw insertion is becoming increasingly common. As in the case presented below, image guided neuronavigation can be used to improve the accuracy and safety of subaxial cervical pedicle screw placement, given their increased difficulty of cannulation relative to the larger pedicles in the thoracolumbar spine. A 49-year-old man presented with a traumatic sagittal split fracture of C4 (AO Classification type A4) and a left lateral mass fracture of C5 (AO Classification type F1) with anterior depression and 50% height loss. MRI revealed evidence of strain of the interspinous/supraspinous ligaments (AO Classification type B2), as well as fluid within the left C4-C5 facet joint. Along with these fractures, the young patient had Klippel-Feil syndrome with autofusion of the C2-3 posterior elements, and a left vertebral artery dissection. He had neck pain but was otherwise neurologically intact. The patient underwent machine-vision image guided C4-C5 unilateral pedicle screw insertion connected by a fixation rod for stabilization and bone graft to augment the instrumented fusion with good outcome. The use of machine vision spinal navigation was able to provide accurate and precise placement of pedicle screws without significantly increasing surgical time. This method has the potential to allow for the safe and accurate insertion of cervical pedicle screws and to reduce the rate of pedicle breach which could avoid significant neurovascular injury.
计算机辅助椎弓根螺钉植入正变得越来越普遍。如下例所示，鉴于相对于胸腰椎较大的椎弓根，颈椎椎弓根置钉的插管难度增加，图像引导神经导航可用于提高颈椎椎弓根螺钉置入的准确性和安全性。一名49岁男性患者，因C4矢状面骨折（AO分型A4型）和C5左侧块骨折（AO分型F1型）伴前方凹陷及高度丢失50%就诊。MRI显示棘间/棘上韧带损伤（AO分型B2型），以及左侧C4-C5小关节内积液。除这些骨折外，该年轻患者还患有Klippel-Feil综合征，C2-3后部结构自动融合，以及左侧椎动脉夹层。他有颈部疼痛，但神经功能完好。患者接受了机器视觉图像引导下的C4-C5单侧椎弓根螺钉植入，并用固定杆连接以稳定脊柱，并进行植骨以增强器械辅助融合，效果良好。使用机器视觉脊柱导航能够准确精确地置入椎弓根螺钉，而不会显著增加手术时间。这种方法有可能实现颈椎椎弓根螺钉的安全准确植入，并降低椎弓根穿孔率，从而避免严重的神经血管损伤。
