Rosa Filezio Marina, Peiro-Garcia Alejandro, Parsons David Llewellyn, Thomas Kenneth, Ferri-de-Barros Fabio
Department of Surgery, University of Calgary, Calgary, AB, Canada.
Ann Med Surg (Lond). 2023 Nov 17;86(1):199-206. doi: 10.1097/MS9.0000000000001515. eCollection 2024 Jan.
STUDY DESIGN: Prospective experimental study. OBJECTIVE: To compare the accuracy of O-Arm-acquired radiographic and computed tomography (CT) evaluation of thoracic pedicle screw placement with open laminectomy in a simulation laboratory. SUMMARY OF BACKGROUND DATA: Improving surgical safety and procedural efficiency during thoracic posterior spine instrumentation is essential for decreasing complication rates and possible related risks. The most common way of verifying the position of pedicle screws during the surgical procedure and immediately postoperatively is to acquire intraoperative fluoroscopic images and plain radiographs of the spine, respectively. Laboratory simulated surgery is a valuable tool to evaluate the accuracy of those exams. METHODS: Twenty simulation models of scoliosis from T3 to T7 were instrumented by five spine fellows (total of 200 pedicle screws), followed by radiographic and CT images acquired with the assistance of the O-Arm which were evaluated by three independent raters. A fellowship-trained spine neurosurgeon performed laminectomies on the instrumented levels and assessed pedicle integrity (gold standard). RESULTS: Forty-eight breaches were identified in the axial direct view after laminectomy. Of those, eighteen breaches were classified as unacceptable. Regarding the sagittal direct view, four breaches were observed, three of which were classified as unacceptable. Overall, both O-arm radiographic and CT evaluations had a significantly high negative predicted value but a low positive predicted value to identify unacceptable breaches, especially in the sagittal plane. The frequency of missed breaches by all three examiners was high, particularly in the sagittal plane. CONCLUSION: Postoperative evaluation of pedicle screws using O-arm-acquired radiographic or CT images may underdiagnose the presence of breaches. In our study, sagittal breaches were more difficult to diagnose than axial breaches. Although most breaches do not have clinical repercussions, this study suggests that this modality of postoperative radiographic assessment may be inaccurate. LEVEL OF EVIDENCE: 4.
研究设计：前瞻性实验研究。 目的：在模拟实验室中，比较O型臂获取的X线片和计算机断层扫描（CT）评估胸椎椎弓根螺钉置入与开放椎板切除术的准确性。 背景资料总结：提高胸椎后路脊柱内固定手术的安全性和手术效率对于降低并发症发生率及可能的相关风险至关重要。在手术过程中和术后立即验证椎弓根螺钉位置的最常用方法分别是获取术中透视图像和脊柱平片。实验室模拟手术是评估这些检查准确性的有价值工具。 方法：由五名脊柱专科住院医师对20个T3至T7的脊柱侧弯模拟模型进行内固定（共200枚椎弓根螺钉），随后在O型臂辅助下获取X线片和CT图像，由三名独立评估者进行评估。一名经过专科培训的脊柱神经外科医生对置入内固定的节段进行椎板切除术，并评估椎弓根完整性（金标准）。 结果：椎板切除术后在轴向直视下发现48处穿孔。其中，18处穿孔被归类为不可接受。在矢状直视下，观察到4处穿孔，其中3处被归类为不可接受。总体而言，O型臂X线片和CT评估在识别不可接受的穿孔方面均具有显著较高的阴性预测值，但阳性预测值较低，尤其是在矢状面。所有三名检查者漏诊穿孔的频率都很高，尤其是在矢状面。 结论：使用O型臂获取的X线片或CT图像对椎弓根螺钉进行术后评估可能会漏诊穿孔的存在。在我们的研究中，矢状面穿孔比轴位面穿孔更难诊断。尽管大多数穿孔没有临床影响，但本研究表明这种术后X线评估方式可能不准确。 证据级别：4级。
Ann Med Surg (Lond). 2023-11-17
Spine J. 2017-11-16
Spine (Phila Pa 1976). 2000-7-1
N Am Spine Soc J. 2021-1-23
Adv Simul (Lond). 2017-9-20
Zotero 插件
