Lin Xuxin, Chang Qing, Shang Lijie, Shen Suhong, Fu Zhuo, Wang Yifan, Zhou Lufan, Fu Hao, Zhao Gang
Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China.
First Department of Minimally Invasive Spine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Nov 15;37(11):1403-1409. doi: 10.7507/1002-1892.202308067.
To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.
Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( >0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.
The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( <0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( >0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( <0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( >0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( >0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( =0.677, <0.001; =0.222, =0.012), while in group B, neither of them was correlated with BMI ( =0.224, =0.233; =0.034, =0.697).
UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
比较O型臂导航和超声容积导航（UVN）在微创经椎间孔腰椎椎间融合术（MIS-TLIF）手术中引导螺钉置入的有效性。
纳入2022年6月至2023年6月期间因腰椎间盘突出症接受MIS-TLIF手术且符合入选标准的60例患者。将他们随机分为A组（MIS-TLIF手术中由UVN引导螺钉置入）或B组（MIS-TLIF手术中由O型臂导航引导螺钉置入），每组30例。两组患者的基线数据，包括性别、年龄、体重指数和手术节段，差异无统计学意义（>0.05）。记录并计算术中数据，包括平均单枚螺钉置入时间、总辐射剂量和平均单枚螺钉有效辐射剂量。术后10天进行X线片和CT扫描，以评估螺钉置入准确性并评估小关节侵犯情况。采用Pearson相关分析和Spearman相关分析观察研究参数（平均单枚螺钉置入时间和螺钉置入准确性分级）与体重指数之间的关系。
B组平均单枚螺钉置入时间明显短于A组，B组单节段和多节段的总辐射剂量及平均单枚螺钉有效辐射剂量均明显高于A组（<0.05）。B组单节段和多节段的总辐射剂量差异无统计学意义（>0.05），而A组多节段的总辐射剂量明显高于单节段（<0.05）。两组螺钉植入准确性差异无统计学意义（>0.05）。两组中，1级和2级螺钉均突破椎弓根外壁，无螺钉突破椎弓根内壁。两组小关节侵犯率差异无统计学意义（>0.05）。在A组中，平均单枚螺钉置入时间和螺钉置入准确性分级均与体重指数呈正相关（=0.677，<0.001；=0.222，=0.012），而在B组中，两者均与体重指数无相关性（=0.224，=0.233；=0.034，=0.697）。
MIS-TLIF手术中UVN引导螺钉置入在效率、可视化和准确性方面与O型臂导航相当，同时显著减少辐射暴露。然而，它可能受肥胖等因素影响，存在一定局限性。
