Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Eur Spine J. 2024 May;33(5):2031-2042. doi: 10.1007/s00586-024-08222-9. Epub 2024 Mar 28.
To assess whether the intention to intraoperatively reposition pedicle screws differs when spine surgeons evaluate the same screws with 2D imaging or 3D imaging.
In this online survey study, 21 spine surgeons evaluated eight pedicle screws from patients who had undergone posterior spinal fixation. In a simulated intraoperative setting, surgeons had to decide if they would reposition a marked pedicle screw based on its position in the provided radiologic imaging. The eight assessed pedicle screws varied in radiologic position, including two screws positioned within the pedicle, two breaching the pedicle cortex < 2 mm, two breaching the pedicle cortex 2-4 mm, and two positioned completely outside the pedicle. Surgeons assessed each pedicle screw twice without knowing and in random order: once with a scrollable three-dimensional (3D) image and once with two oblique fluoroscopic two-dimensional (2D) images.
Almost all surgeons (19/21) intended to reposition more pedicle screws based on 3D imaging than on 2D imaging, with a mean number of pedicle screws to be repositioned of, respectively, 4.1 (± 1.3) and 2.0 (± 1.3; p < 0.001). Surgeons intended to reposition two screws placed completely outside the pedicle, one breaching 2-4mm, and one breaching < 2 mm more often based on 3D imaging.
When provided with 3D imaging, spine surgeons not only intend to intraoperatively reposition pedicle screws at risk of causing postoperative complications more often but also screws with acceptable positions. This study highlights the potential of intraoperative 3D imaging as well as the need for consensus on how to act on intraoperative 3D information.
评估脊柱外科医生在使用二维（2D）成像或三维（3D）成像评估相同螺钉时，术中重新定位椎弓根螺钉的意图是否不同。
在这项在线调查研究中，21 名脊柱外科医生评估了 8 枚来自接受后路脊柱固定术患者的椎弓根螺钉。在模拟的术中环境中，外科医生必须根据提供的影像学图像中螺钉的位置决定是否重新定位标记的椎弓根螺钉。评估的 8 枚椎弓根螺钉在影像学位置上存在差异，包括 2 枚位于椎弓根内，2 枚突破椎弓根皮质<2mm，2 枚突破椎弓根皮质 2-4mm，2 枚完全位于椎弓根外。外科医生在不知道且随机顺序的情况下两次评估每个椎弓根螺钉：一次使用可滚动的三维（3D）图像，一次使用两个斜位透视二维（2D）图像。
几乎所有外科医生（21 名中的 19 名）都打算根据 3D 成像比 2D 成像更多地重新定位椎弓根螺钉，分别计划重新定位 4.1（±1.3）和 2.0（±1.3；p<0.001）枚椎弓根螺钉。外科医生更倾向于根据 3D 成像重新定位 2 枚完全位于椎弓根外的螺钉、1 枚突破 2-4mm 的螺钉和 1 枚突破<2mm 的螺钉。
当提供 3D 成像时，脊柱外科医生不仅更倾向于在术中重新定位有术后并发症风险的椎弓根螺钉，而且还倾向于重新定位具有可接受位置的螺钉。本研究强调了术中 3D 成像的潜力，以及对如何处理术中 3D 信息达成共识的必要性。
