Park Jiwon, Yeom Jin S, Kim Yeonho, Hwang Yoonjoong, Kim Namkug, Park Sang-Min
Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Republic of Korea.
Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea.
Medicina (Kaunas). 2024 Dec 11;60(12):2040. doi: 10.3390/medicina60122040.
: Recent advances in intraoperative navigation systems have improved the accuracy of pedicle screw placement in spine surgery. However, many hospitals have limited access to these advanced technologies due to resource constraints. In such settings, postoperative computed tomography (CT) evaluation remains crucial for assessing screw placement and related potential complications. Metal artifacts in CT scans often compromise the diagnostic accuracy. This study aimed to develop and validate three-dimensional (3-D) reconstruction software to enhance screw localization accuracy and facilitate its practical clinical application. : This study included two phases: 3-D software development utilizing specific threshold values of Hounsfield units for titanium screws followed by internal validation. For validation, fifty pedicle screws were inserted into porcine lumbar vertebrae with random violation (superior, inferior, medial, or lateral). Three fellowship-trained surgeons evaluated screw positions using both conventional CT bone window settings and the developed software. Additional clinical validation involving 386 pedicle screws from cervical to lumbar spine was performed by two surgeons. The software demonstrated significantly higher specificity (83% vs. 63%) and positive predictive value (96% vs. 91%) compared to conventional CT bone window settings, while maintaining 100% sensitivity and negative predictive value. Interobserver reliability was excellent for both methods (0.961 for bone window vs. 0.990 for software). In clinical validation, the software showed superior intraobserver (0.83 vs. 0.74) and interobserver reliability (0.855 vs. 0.513) compared to picture archiving and communication system (PACS) workstation evaluation. : The developed software provides improved accuracy and reliability in pedicle screw position evaluation through distinct screw outline visualization and metal artifact reduction. Its equipment-independent nature and cost-effectiveness make it particularly valuable for clinical implementation.
术中导航系统的最新进展提高了脊柱手术中椎弓根螺钉置入的准确性。然而，由于资源限制，许多医院难以获得这些先进技术。在这种情况下，术后计算机断层扫描（CT）评估对于评估螺钉置入情况及相关潜在并发症仍然至关重要。CT扫描中的金属伪影常常会影响诊断准确性。本研究旨在开发并验证三维（3-D）重建软件，以提高螺钉定位准确性并促进其在临床实际中的应用。
利用钛螺钉的特定亨氏单位阈值开发3-D软件，随后进行内部验证。为进行验证，将50枚椎弓根螺钉随机违规（向上、向下、向内侧或向外侧）插入猪腰椎。三位经过专科培训的外科医生使用传统CT骨窗设置和开发的软件评估螺钉位置。两位外科医生对涉及从颈椎到腰椎的386枚椎弓根螺钉进行了额外的临床验证。与传统CT骨窗设置相比，该软件显示出显著更高的特异性（83%对63%）和阳性预测值（96%对91%），同时保持100%的敏感性和阴性预测值。两种方法的观察者间可靠性均极佳（骨窗为0.961，软件为0.990）。在临床验证中，与图像存档与通信系统（PACS）工作站评估相比，该软件显示出更高的观察者内（0.83对0.74）和观察者间可靠性（0.855对0.513）。
开发的软件通过清晰的螺钉轮廓可视化和减少金属伪影，提高了椎弓根螺钉位置评估中的准确性和可靠性。其与设备无关的特性和成本效益使其在临床应用中特别有价值。
