Vadalà Gianluca, Papalia Giuseppe Francesco, Russo Fabrizio, Brigato Paolo, Ambrosio Luca, Papalia Rocco, Denaro Vincenzo
Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy.
Neurospine. 2024 Mar;21(1):76-82. doi: 10.14245/ns.2347106.553. Epub 2024 Mar 31.
Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy.
A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed.
The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications.
This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.
多项研究主张，与传统二维（2D）荧光透视相比，在锥束计算机断层扫描（CBCT）引导下进行椎弓根螺钉置入的准确性更高。导航系统在围手术期和术后结果方面的优越性仍是一个有争议的话题。本研究旨在比较采用术中CBCT导航与2D荧光透视对退变性腰椎滑脱（DLS）患者进行椎弓根螺钉固定时的手术时间、螺钉置入时间和准确性、总辐射剂量、围手术期和术后结果。
对接受单节段DLS治疗并采用手术CBCT导航进行后路腰椎器械固定（NV组）或2D荧光透视辅助徒手技术（FH组）的患者进行回顾性分析。评估人口统计学、螺钉置入时间和准确性、手术时间、总辐射剂量、术中失血量、螺钉翻修率、并发症和住院时间（LOS）。
该研究共纳入30例患者（NV组：n = 15；FH组：n = 15）。与FH组相比，NV组的平均螺钉置入时间、手术时间和LOS显著缩短（p < 0.05）。NV组的总辐射剂量显著更高（p < 0.0001）。在失血量和术后并发症方面未发现显著差异。
本研究表明，尽管术中辐射暴露较高，但与2D荧光透视相比，术中CBCT导航下单节段腰椎椎弓根螺钉固定在平均螺钉置入时间、手术时间和LOS方面更具优势。
