Dharnipragada Rajiv, Ladd Bryan, Jones Kristen, Polly David
Medical School, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Radiol Case Rep. 2022 May 7;17(7):2400-2403. doi: 10.1016/j.radcr.2022.03.078. eCollection 2022 Jul.
Wrong-level spinal surgery (WLSS) can lead to increased morbidity, cost, and worse long-term outcomes. Current intraoperative localization methods rely on counting spinal levels from a known reference location using fluoroscopy. Miscounting from a reference is an intraoperative error that leads to WLSS, especially for those with anatomical variations. The problem is exacerbated when fluoroscopy is not able to produce images with the clarity needed to confidently count levels, a prevalent issue for obese patients. A new feature called the "2D Long Film'' is available for the Medtronic (Minneapolis, MN) O-arm Surgical Imaging System. Using this novel technology and standard fluoroscopy, this study reports the imaging of two obese adult female patients with a body mass index of 36.9 and 42.0 undergoing transforaminal thoracic interbody fusion. Fluoroscopy images of obese patients are difficult to capture for two reasons: increased scatter and restricted field of view. This report demonstrates that 2D Long Film can improve both these issues for obese patients in need of thoracic localization. The 2D Long Film captures existing instrumentation, localization needles, and the vertebral levels in a clear single image. We display the differences between standard fluoroscopy and the 2D Long Film for thoracic level localization, demonstrating a potential new standard of care and better visualization, leading to a less challenging vertebrae localization process, potentially mitigating WLSS risk. The quality of this new 2D Long Film feature could also reduce time in the operating room and the necessity of other visualization methods.
错节段脊柱手术（WLSS）可导致发病率增加、成本上升以及更差的长期预后。当前的术中定位方法依赖于使用荧光透视从已知参考位置开始计数脊柱节段。参考计数错误是导致WLSS的术中失误，对于那些存在解剖变异的患者尤其如此。当荧光透视无法生成清晰到足以可靠计数节段的图像时，问题会更加严重，这在肥胖患者中是一个普遍存在的问题。美敦力公司（明尼阿波利斯，明尼苏达州）的O型臂手术成像系统有一项名为“二维长片”的新功能。本研究报告了使用这项新技术和标准荧光透视对两名体重指数分别为36.9和42.0的肥胖成年女性患者进行经椎间孔胸椎椎间融合术的成像情况。肥胖患者的荧光透视图像难以获取，原因有两个：散射增加和视野受限。本报告表明，二维长片可以改善肥胖患者在需要胸椎定位时的这两个问题。二维长片能在一张清晰的图像中捕捉到现有的器械、定位针和椎体节段。我们展示了标准荧光透视和二维长片在胸椎节段定位方面的差异，证明了一种潜在的新护理标准以及更好的可视化效果，从而使椎体定位过程更具挑战性，有可能降低WLSS风险。这种新二维长片功能的质量还可以减少手术室时间以及其他可视化方法的必要性。
