Gengatharan Dhivakaran, Wong Walter Soon Yaw, Lin Lee Kai, Thng John Wen Cong, Yilun Huang
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Spine Surg Relat Res. 2024 Dec 20;9(2):258-262. doi: 10.22603/ssrr.2024-0257. eCollection 2025 Mar 27.
Endoscopic Spine Surgery (ESS) has begun to gain traction as an alternative to traditional microscopic spine surgery, particularly for lumbar decompression. However, one of the challenges associated with this approach is the steep learning curve. A recent advancement in this field aims to flatten the learning curve by incorporating navigation into ESS. This technology provides valuable information on the extent of decompression, confirms the working level, and reduces radiation exposure.
We aimed to describe our experience using electromagnetic navigation in biportal endoscopic spine surgery (BESS). The surgical technique is initiated by positioning the patient prone on a radiolucent table. The navigation field generator is positioned over the caudal end of the patient. The navigation system is set up with patient mappers at the desired working levels. The patient tracker is implanted. The final fluoroscopy images are captured in anteroposterior and lateral views. Subsequently, standard incisions are made, and endoscopic decompression is performed. When required, various instruments can be used to confirm the level, angulation, and extent of decompression.
Our experience showed that this approach reduced the need for intraoperative imaging and provided an accurate alternative to repeated intraoperative imaging. However, it does involve a significantly long setup. Further trials of larger scale are required to determine its efficacy.
作为传统显微脊柱手术的替代方法，内镜脊柱手术（ESS）已开始受到关注，尤其是在腰椎减压方面。然而，这种方法面临的挑战之一是学习曲线陡峭。该领域最近的一项进展旨在通过将导航技术融入ESS来平缓学习曲线。这项技术提供了有关减压范围的有价值信息，确认了手术节段，并减少了辐射暴露。
我们旨在描述我们在双门内镜脊柱手术（BESS）中使用电磁导航的经验。手术技术首先将患者俯卧在可透射线的手术台上。将导航场发生器放置在患者的尾端上方。在所需的手术节段使用患者映射器设置导航系统。植入患者跟踪器。在前后位和侧位视图中采集最终的荧光透视图像。随后，进行标准切口，并进行内镜减压。如有需要，可使用各种器械来确认减压的节段、角度和范围。
我们的经验表明，这种方法减少了术中成像的需求，并为反复的术中成像提供了一种准确的替代方法。然而，它确实需要很长的设置时间。需要进行更大规模的进一步试验来确定其疗效。
