Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy.
Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.
J Orthop Traumatol. 2023 Jun 29;24(1):32. doi: 10.1186/s10195-023-00696-5.
Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS.
An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein-Robbins scale.
A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein-Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E.
The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement. Level of Evidence Level 3. Trial registration Not applicable.
微创脊柱外科是一个活跃且深入研究的领域。影像引导经皮椎弓根螺钉（PPS）置入术是标准徒手技术的有效替代方法，这要归功于提供潜在准确性和安全性改进的技术进步。在此，我们描述了一种利用神经导航和术中神经生理监测（IONM）相结合的微创 PPS 手术技术的临床结果。
在 PPS 的三步骤技术中，将基于术中计算机断层扫描（CT）的神经导航系统与 IONM 相结合。收集临床和影像学数据，以评估该程序的安全性和有效性。根据 Gertzbein-Robbins 量表对 PPS 放置的准确性进行分类。
在 49 名患者中总共置入了 230 枚螺钉。只有两枚螺钉位置不当（0.8%）；然而，这些患者没有经历神经根病的临床症状。根据 Gertzbein-Robbins 量表，大多数螺钉（221 枚，96.1%）被归类为 A 级，7 枚螺钉被归类为 B 级，1 枚螺钉被归类为 D 级，最后 1 枚螺钉被归类为 E 级。
所提出的三步骤导航经皮手术为腰椎和骶骨椎弓根螺钉置入提供了一种安全准确的替代传统技术的方法。
3 级。试验注册：不适用。
