术中影像引导下椎弓根螺钉的评估：准确性与一致性的前瞻性研究
Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement.
作者信息
Åkerstedt Josefin, Berglund Anders, Kolakowski Przemyslaw, Sliwinski Piotr, Jablonski Marcin, Bobinski Lukas
机构信息
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
Spine Unit, Department of Orthopedics, Umeå University Hospital, Umeå, Sweden.
出版信息
Int J Spine Surg. 2023 Oct;17(5):684-689. doi: 10.14444/8550. Epub 2023 Oct 25.
BACKGROUND
Intraoperative (IO) image guidance surgery using 3-dimensional fluoroscopic navigation methods, such as the O-arm system, has improved the accuracy of pedicle screw placement in instrumented spine surgery. IO and postoperative (PO) validation of the implant's correct position from radiological images is a decisive step to ensure patient safety and avoidance of complications related to implant misplacement. In this prospective single-center study, the authors investigated the accuracy and agreement of assessment of pedicle screws from IO O-arm images in comparison to PO computed tomography images. This study aimed to determine whether final evaluation of pedicle screws can safely be conducted from IO images that supersedes the PO computed tomography control.
METHODS
A prospective single-center study was carried out at the Spine Unit in the Department of Orthopedics at Umeå University Hospital between 2019 and 2021. All patients enrolled in the study underwent instrumented thoracolumbar spine surgery using navigation. Imaging data were obtained from IO and PO examinations. Four reviewers-2 attending senior spine surgeons, 1 final year resident in orthopedics, and 1 attending neuroradiologist-classified pedicle screws using the Gertzbein and Robbins classification system. Agreement and accuracy of the reviewers were studied to evaluate the assessment of pedicle screws from IO and PO images.
RESULTS
A total of 70 patients (422 screws) were included in the study. There was high accuracy among surgeons both on IO and PO images (0.96-0.97, 95% CI [0.94-0.99] and 0.97, 95% CI [0.94-0.99], respectively), and the overall agreement between all raters was 92% to 98% (95% CI [0.90, 1.00]). The discrepancy in assessment between optimal (Group 1) and suboptimal (Group 2) screws between IO and PO images was as low as 1% to 1.7%, which indicates that very few suboptimal screws are missed in the assessment of IO images.
CONCLUSIONS
The assessment of navigated pedicle screws using IO images is safe and reliable and may replace the need for further assessment using PO imaging.
背景
使用三维荧光透视导航方法（如O型臂系统）的术中（IO）图像引导手术提高了脊柱内固定手术中椎弓根螺钉置入的准确性。通过放射影像对植入物正确位置进行术中及术后（PO）验证是确保患者安全并避免与植入物误置相关并发症的决定性步骤。在这项前瞻性单中心研究中，作者比较了术中O型臂图像与术后计算机断层扫描图像对椎弓根螺钉评估的准确性和一致性。本研究旨在确定是否可以通过术中图像安全地进行椎弓根螺钉的最终评估，从而取代术后计算机断层扫描对照。
方法
2019年至2021年期间，于乌梅大学医院骨科脊柱科开展了一项前瞻性单中心研究。所有纳入研究的患者均接受了使用导航的胸腰椎脊柱内固定手术。从术中及术后检查中获取影像数据。四名评估者——2名脊柱外科主治医生、1名骨科住院医师最后一年学员以及1名神经放射科主治医生——使用Gertzbein和Robbins分类系统对椎弓根螺钉进行分类。研究评估者的一致性和准确性，以评价术中及术后图像对椎弓根螺钉的评估。
结果
本研究共纳入70例患者（422枚螺钉）。外科医生对术中及术后图像的评估准确性均较高（分别为0.96 - 0.97，95%置信区间[0.94 - 0.99]和0.97，95%置信区间[0.94 - 0.99]），所有评估者之间的总体一致性为92%至98%（95%置信区间[0.90, 1.00]）。术中及术后图像之间，最佳（第1组）和次优（第2组）螺钉评估的差异低至1%至1.7%，这表明在术中图像评估中极少遗漏次优螺钉。
结论
使用术中图像评估导航椎弓根螺钉是安全可靠的，可能无需进一步使用术后成像进行评估。
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