Neal Kevin M, Krombholz Kylie, Doshi Mona
Orthopaedics Department, Nemours Children's Health, Jacksonville, FL, USA.
Florida State University College of Medicine, Tallahassee, FL, USA.
Spine Deform. 2025 Jan;13(1):153-158. doi: 10.1007/s43390-024-00970-4. Epub 2024 Sep 18.
To determine the accuracy of screw placement using fluoroscopy and anatomic landmarks during vertebral body tethering (VBT) surgery.
Ten patients with 73 VBT screws were converted to posterior spinal fusion (PSF) after continued curve progression. The positions of each VBT screw were analyzed using intraoperative computed tomography (CT) scans performed for image guidance during VBT. Differences for screws placed using an open versus thoracoscopic approach were noted for the screw position in each vertebra, distance from the spinal canal, unicortical versus bicortical placement, the distance of screw tips from the thoracic aorta, and impingement of screws on adjacent rib heads.
Seventy three (73) screws in ten (10) patients were available for analysis. Only 21% of screws were placed traversing the middle one-third of the vertebral body, without spinal canal penetration, with the distal tip placed unicortically or bicortically as planned, and without touching the thoracic aorta. The rates of non-ideal screw placement were not significantly different for screws placed via thoracoscopic versus open approaches. Five (5) screws (6.8%) penetrated the spinal canal 1-2 mm, but without known clinical sequelae.
The majority of VBT screws available for analysis were placed in non-ideal positions, suggesting that accurate screw placement using intraoperative fluoroscopy and anatomic landmarks can be challenging, but without adverse clinical consequences.
确定在椎体拴系术（VBT）手术中使用荧光透视和解剖标志进行螺钉置入的准确性。
10例患者共置入73枚VBT螺钉，在脊柱侧弯持续进展后改行后路脊柱融合术（PSF）。利用VBT术中为图像引导而进行的计算机断层扫描（CT）分析每枚VBT螺钉的位置。记录采用开放手术与胸腔镜手术置入螺钉时在每个椎体中的螺钉位置、与椎管的距离、单侧皮质与双侧皮质置入情况、螺钉尖端与胸主动脉的距离以及螺钉对相邻肋骨头的压迫情况。
10例患者的73枚螺钉可供分析。只有21%的螺钉置入时穿过椎体中三分之一，未穿透椎管，远端尖端按计划单侧皮质或双侧皮质置入，且未触及胸主动脉。经胸腔镜与开放手术置入的螺钉，其非理想置入率无显著差异。5枚（6.8%）螺钉穿透椎管1 - 2毫米，但无已知临床后遗症。
可供分析的大多数VBT螺钉置入位置不理想，这表明使用术中荧光透视和解剖标志进行准确的螺钉置入具有挑战性，但无不良临床后果。
