Mandelka Eric, Gierse Jula, Zimmermann Felix, Gruetzner Paul A, Franke Jochen, Vetter Sven Y
Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
Brain Spine. 2023 Jul 11;3:101780. doi: 10.1016/j.bas.2023.101780. eCollection 2023.
There is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited.
The aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well.
In this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups.
Screw accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group.
This study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.
有充分证据表明，使用脊柱导航可提高胸腰椎椎弓根螺钉置入的准确性。然而，迄今为止，关于导航使用对螺钉直径与椎弓根宽度比值影响的证据仍然有限。
本研究的目的是探讨导航在胸腰椎椎弓根螺钉置入中不仅对螺钉准确性的影响，而且对螺钉直径与椎弓根宽度比值的影响。
在这项单中心单术者研究中，前瞻性纳入了45例行导航下胸腰椎椎弓根螺钉置入的患者。将结果与在透视引导下进行螺钉置入的匹配对照组患者进行比较。比较两组中每枚螺钉的准确性以及螺钉直径与椎弓根宽度比值。
与透视引导组相比，导航组的螺钉准确性显著更高，同时螺钉直径与椎弓根宽度比值显著增加约10%。此外，研究组的术中辐射剂量和手术时间均有降低趋势。
本研究表明，导航下胸腰椎椎弓根螺钉置入不仅提高了螺钉置入的准确性，还便于选择合适的螺钉尺寸，根据文献，这对固定强度有积极影响。同时，导航的使用并未对手术所需时间或患者术中辐射暴露产生负面影响。
