Nam Yunjin, Chang Dong-Gune, Kim Hong Jin, Kim Young Ha, Lee Sangmin, Yang Jae Hyuk, Suh Seung Woo
Department of Orthopaedics, Korea University Guro Hospital, Seoul, Korea.
Department of Orthopaedics, Inje University Sanggye Paik Hospital, Seoul, Korea.
Neurospine. 2023 Mar;20(1):240-247. doi: 10.14245/ns.2244646.323. Epub 2023 Mar 31.
The safety and clinical usefulness of minimally invasive scoliosis surgery (MISS) has been reported in various studies. However, freehand pedicle screwing in MISS remains technically challenging. The purpose of this study is to evaluate the accuracy and safety of pedicle screw placement using the freehand technique in adolescent idiopathic scoliosis (AIS) patients treated with MISS compared to conventional open scoliosis surgery (COSS).
We included 76 patients who underwent deformity correction for AIS. Computed tomography scans were used to assess screw violations divided into 2 groups according to the surgical technique: MISS or COSS. Anterior violations were classified into grade 0, 1 (no contact with internal organs), and 2 (contact with internal organs). Medial and lateral violations were classified into grade 0, 1 ( < 2 mm), and 3 ( ≥ 2 mm). grade 2 were considered critical violations.
A total of 630 and 1,174 pedicle screws were inserted in the MISS and COSS groups, respectively. The overall critical violation rates of the MISS and COSS groups were 16.8% (106 screws) and 14.0% (165 screws) (p = 0.116). Medial critical violations on the left side in the middle thoracic region frequently occurred in the MISS group compared to the COSS group (p = 0.003). There were no statistical differences in the complications.
Pedicle screw placement using the freehand technique in MISS for AIS patients provided similar accuracy and safety compared to COSS. Pedicle screws inserted on the left side of the middle thoracic region, exhibited more medial critical violations in the MISS group.
多项研究报道了微创脊柱侧弯手术（MISS）的安全性及临床实用性。然而，MISS中的徒手椎弓根螺钉置入在技术上仍具有挑战性。本研究旨在评估在接受MISS治疗的青少年特发性脊柱侧弯（AIS）患者中，与传统开放性脊柱侧弯手术（COSS）相比，徒手技术置入椎弓根螺钉的准确性和安全性。
我们纳入了76例接受AIS畸形矫正的患者。根据手术技术将计算机断层扫描用于评估螺钉穿出情况，分为两组：MISS组或COSS组。前方穿出分为0级、1级（未接触内脏器官）和2级（接触内脏器官）。内侧和外侧穿出分为0级、1级（<2mm）和3级（≥2mm）。2级被视为严重穿出。
MISS组和COSS组分别共置入630枚和1174枚椎弓根螺钉。MISS组和COSS组的总体严重穿出率分别为16.8%（106枚螺钉）和14.0%（165枚螺钉）（p = 0.116）。与COSS组相比，MISS组中胸段左侧的内侧严重穿出更为常见（p = 0.003）。并发症方面无统计学差异。
在AIS患者的MISS中，徒手技术置入椎弓根螺钉与COSS相比，准确性和安全性相似。在MISS组中，中胸段左侧置入的椎弓根螺钉出现更多内侧严重穿出情况。
