Department of Neurological Surgery, UC San Diego, San Diego, CA, USA.
Department of Neuroradiology, UC San Diego, San Diego, CA, USA.
J Robot Surg. 2023 Dec;17(6):2729-2734. doi: 10.1007/s11701-023-01686-9. Epub 2023 Sep 4.
Retrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included. Neuromonitoring reports were culled for mA threshold to triggered EMG response for all redirected screws. Intraoperative, post-de novo screw placement images (fluoroscopy scout and intraoperative CT) and post-redirection intraoperative scoliosis films and post-operative scoliosis films were independently reviewed by a senior neuroradiologist. Fifty redirected screws in the thoracic, lumbar, sacral, and ilium were identified as misdirected and redirected via navigation. The new trajectory of all screws was confirmed satisfactory by independent review between a senior neuroradiologist and neurosurgeon. Four screws could not be verified by post-operative imaging (4/50, 8%). All triggered EMG stimulated > 15 mA. No screws required return to the operating room for revision. No patients experienced a post-operative deficit. Redirection of misdirected thoracolumbar and sacroiliac screws can be performed using intraoperative CT and navigation as a means to detect and directly visualize appropriate placement.
回顾了一家机构的一位外科医生在 2020 年 3 月 12 日至 2021 年 8 月 13 日期间进行的所有超过 3 个节段的胸腰椎和/或骶髂融合手术，这些手术均涉及二次导航的脊柱内固定。所有在术中 CT 扫描中被确定为定位错误的螺钉都被包括在内。所有重新定位的螺钉的神经监测报告均剔除了 mA 阈值，以触发 EMG 反应。由一位资深神经放射科医生独立审查了术中、新螺钉放置后的图像（透视导丝和术中 CT）、术后脊柱侧弯片和术后脊柱侧弯片。50 颗在胸椎、腰椎、骶骨和髂骨中被确定为定位错误并通过导航重新定位的螺钉。所有螺钉的新轨迹均由资深神经放射科医生和神经外科医生进行独立评估，确认满意。4 颗螺钉无法通过术后影像学（4/50，8%）验证。所有被触发的 EMG 刺激均超过 15 mA。没有螺钉需要返回手术室进行修正。没有患者出现术后缺陷。通过术中 CT 和导航进行胸腰椎和骶髂螺钉的重新定位，是一种检测和直接可视化合适放置的方法。
