术中 CT 引导导航与透视用于 192 例经皮椎弓根螺钉置入术的比较分析。
Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis.
机构信息
Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.
Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.
出版信息
J Orthop Traumatol. 2022 Sep 1;23(1):44. doi: 10.1186/s10195-022-00661-8.
BACKGROUND
Percutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage.
MATERIALS AND METHODS
A total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion ± interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A-E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery.
RESULTS
A total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4-L5. Median ED received from patients was 1.504 mSv (0.494-4.406) in FA technique and 21.130 mSv (10.840-30.390) in CTNav approach (p < 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p < 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p < 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771).
CONCLUSIONS
CTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique.
LEVEL OF EVIDENCE
Level 3.
背景
经皮椎弓根螺钉（PPS）置入是几种微创脊柱手术（MISS）的关键步骤。传统的 PPS 技术利用 C 臂透视辅助（FA）。最近，已经开发出了用于 PPS 的新型术中成像技术，包括 CT 引导导航（CTNav）。本研究旨在比较 FA 和 CTNav 技术在准确性、并发症和辐射剂量方面的差异。
材料和方法
回顾性分析了 192 例退行性腰椎滑脱伴椎管狭窄患者，这些患者通过经椎间孔入路（TLIF）接受了 MISS 后路融合加椎间融合。经皮使用标准 C 臂透视引导（FA 组）或 CT 导航（CTNav 组）置入椎弓根螺钉。术中有效剂量（ED，mSv）进行了测量。术后使用 Gertzbein 和 Robbins 分类（A-E 级）对 CT 扫描进行螺钉放置准确性评估。比较两组术前和术后的 Oswestry 残疾指数（ODI）和视觉模拟评分（VAS）。
结果
FA 组和 CTNav 组分别进行了 101 例和 91 例手术。两组的中位年龄均为 61 岁，最常治疗的节段为 L4-L5。FA 技术中患者接受的中位 ED 为 1.504 mSv（0.494-4.406），CTNav 技术中为 21.130 mSv（10.840-30.390）（p<0.001）。CTNav 组 A 级和 B 级螺钉的比例明显更高（96.4%对 92%，p<0.001），而 FA 组有 16 级 E 级螺钉，CTNav 组无 0 级 E 级螺钉（p<0.001）。FA 组和 CTNav 组分别报告了 7 例和 5 例并发症（p=0.771）。
结论
与 FA 技术相比，CTNav 技术可提高椎弓根螺钉的准确性，而不影响手术时间。然而，由于螺钉位置不当，CTNav 和 FA 技术之间的再手术率没有显著差异。CTNav 技术患者的辐射暴露明显更高。
证据水平
3 级。
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