Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
World Neurosurg. 2023 Aug;176:e226-e231. doi: 10.1016/j.wneu.2023.05.035. Epub 2023 May 16.
To compare the efficacy of intervertebral disc space preparation via an anterior-to-psoas (ATP) approach using conventional fluoroscopy (Flu) and computer tomography (CT)-based navigation by evaluating the disc remaining area.
We equally assigned 24 lumbar disc levels from 6 cadavers into Flu and CT-based navigation (Nav) groups. Two surgeons performed disc space preparation using the ATP approach in both groups. Digital images of each vertebral endplate were obtained, and the remaining disc tissue was calculated in total and in quadrants. Operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, and access angle were recorded.
The overall percentage of remaining disc tissue was significantly less in the Nav group than in the Flu group (32.7% vs. 43.3% respectively, P < 0.001). A significant difference was found in the posterior-ipsilateral (4.2% vs. 7.1%, P = 0.005) and posterior-contralateral (6.1% vs. 10.9%, P = 0.002) quadrants, respectively. No significant between-group difference was found concerning operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, or access angle.
Intraoperative CT-based navigation may improve vertebral endplate preparation quality for an ATP approach, especially in the posterior quadrants. This technique may offer an effective alternative disc space and endplate preparation methods and may help enhance the fusion rates.
通过评估椎间盘剩余面积，比较经前路至腰大肌（ATP）入路进行椎间盘间隙准备时，使用传统透视（Flu）和基于计算机断层扫描（CT）导航的效果。
我们将 6 具尸体的 24 个腰椎间盘水平平均分配到 Flu 组和 CT 导航（Nav）组。两组均由两名外科医生采用 ATP 入路进行椎间盘间隙准备。获得每个椎板终板的数字图像，并计算总椎间盘组织和四个象限的剩余椎间盘组织。记录手术时间、椎间盘去除尝试次数、终板破坏面积、终板破坏节段数和入路角度。
Nav 组的椎间盘剩余组织百分比明显低于 Flu 组（分别为 32.7%和 43.3%，P<0.001）。在后外侧（4.2% vs. 7.1%，P=0.005）和后对侧（6.1% vs. 10.9%，P=0.002）象限，差异有统计学意义。两组在手术时间、椎间盘去除尝试次数、终板破坏面积、终板破坏节段数和入路角度方面无显著差异。
术中基于 CT 的导航可能会提高 ATP 入路的椎板终板准备质量，尤其是在后象限。该技术可能提供一种有效的替代椎间盘间隙和终板准备方法，并有助于提高融合率。
