Berman Daniel, Eleswarapu Ananth, Krystal Jonathan, Hoang Henry
Montefiore Medical Center, Bronx, NY 10467, USA.
Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Clin Med. 2022 Apr 10;11(8):2108. doi: 10.3390/jcm11082108.
Pedicle screw fixation is a technique used to provide rigid fixation in thoracolumbar spine surgery. Safe intraosseous placement of pedicle screws is necessary to provide optimal fixation as well as to avoid damage to adjacent anatomic structures. Despite the wide variety of techniques available, none thus far has been able to fully eliminate the risk of malpositioned screws. Intraoperative 3-dimensional navigation (I3DN) was developed to improve accuracy in the placement of pedicle screws. To our knowledge, no previous studies have investigated whether infection rates are higher with I3DN. A single-institution, retrospective study of patients age > 18 undergoing thoracolumbar fusion and instrumentation was carried out and use of I3DN was recorded. The I3DN group had a significantly greater rate of return to the operating room for culture-positive incision and drainage (17 (4.1%) vs. 1 (0.6%), p = 0.025). In multivariate analysis, the use of I3DM did not reach significance with an OR of 6.49 (0.84−50.02, p = 0.073). Post-operative infections are multifactorial and potential infection risks associated with I3DN need to be weighed against the safety benefits of improved accuracy of pedicle screw positioning.
椎弓根螺钉固定是一种用于胸腰椎手术中提供坚强固定的技术。椎弓根螺钉在骨内的安全置入对于实现最佳固定以及避免损伤相邻解剖结构而言是必要的。尽管有各种各样的可用技术，但迄今为止尚无一种能够完全消除螺钉位置不当的风险。术中三维导航（I3DN）的开发旨在提高椎弓根螺钉置入的准确性。据我们所知，此前尚无研究调查过I3DN是否会使感染率更高。我们进行了一项针对年龄大于18岁接受胸腰椎融合及内固定术患者的单机构回顾性研究，并记录了I3DN的使用情况。I3DN组因切口培养阳性而返回手术室进行切开引流的比例显著更高（17例（4.1%）对1例（0.6%），p = 0.025）。在多因素分析中，I3DM的使用未达到显著水平，比值比为6.49（0.84 - 50.02，p = 0.073）。术后感染是多因素导致的，与I3DN相关的潜在感染风险需要与椎弓根螺钉定位准确性提高带来的安全益处相权衡。
