Gierse Jula, Zimmermann Felix, Grützner Paul A, Stallkamp Jan, Vetter Sven Y, Mandelka Eric
BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery at Heidelberg University, Ludwigshafen, Germany.
Heidelberg University, Heidelberg, Germany.
Global Spine J. 2025 May 19:21925682251343523. doi: 10.1177/21925682251343523.
Study DesignRetrospective cohort study.ObjectivesDue to the close anatomic relationship between the pedicle and neurovascular structures, avoiding pedicle perforations is crucial in pedicle screw placement. Still, the use of larger screws has biomechanical advantages. Intraoperative 2D and 3D imaging, and navigation guidance can be used to combine both goals. The aim of this study was to compare the screw diameter/pedicle width ratio (SPR) and the screw placement accuracy for 3D controlled fluoroscopy-guided pedicle screw placement vs computer navigated transpedicular screw placement in the thoracic and lumbar spine.Methods200 cases of thoracic and lumbar pedicle screw placement, of which 100 cases were performed using intraoperative computer navigation and 100 cases were performed using fluoroscopy-guidance were retrospectively registered. In the fluoroscopy group, intraoperative 3D scans were performed to confirm implant position and allow for potential intraoperative revision. In addition to accuracy and SPR, demographics, dose reports, and procedure times were analyzed.ResultsOverall, 716 fluoroscopy-guided screws were compared with 740 screws placed using navigation. Screw accuracy (83.2% vs 90.5%; = .001) and SPR (0.85 ± 0.17 vs 0.88 ± 0.21; < .001) were significantly higher using navigation compared to fluoroscopic guidance. Furthermore, dose area product (28,545 ± 17,693 vs 20,638 ± 15,856 mGycm; < .001), fluoroscopy time (223.6 ± 93.6 vs 92.3 ± 39.7 seconds; < .001), and procedure time (154.0 ± 81.0 vs 119.7 ± 48.7 min; = .004) were significantly lower using navigation.ConclusionsIntraoperative navigation does not only increase the accuracy of pedicle screw placement, but also allows for the placement of larger screws relative to the pedicle width, which may have biomechanical advantages. Notably, contrary to other studies, the use of navigation did not increase patient radiation exposure or procedure time compared to fluoroscopic guidance.
研究设计
回顾性队列研究。
目的
由于椎弓根与神经血管结构之间存在紧密的解剖关系，在椎弓根螺钉置入过程中避免椎弓根穿孔至关重要。然而，使用较大直径的螺钉具有生物力学优势。术中二维和三维成像以及导航引导可用于兼顾这两个目标。本研究的目的是比较在胸椎和腰椎中，三维控制荧光透视引导下椎弓根螺钉置入与计算机导航经椎弓根螺钉置入的螺钉直径/椎弓根宽度比（SPR）和螺钉置入准确性。
方法
回顾性登记200例胸椎和腰椎椎弓根螺钉置入病例，其中100例使用术中计算机导航进行，100例使用荧光透视引导进行。在荧光透视组中，术中进行三维扫描以确认植入物位置并允许进行潜在的术中修正。除了准确性和SPR外，还分析了人口统计学数据、剂量报告和手术时间。
结果
总体而言，将716枚荧光透视引导下置入的螺钉与740枚使用导航置入的螺钉进行了比较。与荧光透视引导相比，使用导航时螺钉准确性（83.2%对90.5%；P =.001）和SPR（0.85±0.17对0.88±0.21；P <.001）显著更高。此外，使用导航时剂量面积乘积（28,545±17,693对20,638±15,856 mGycm；P <.001）、荧光透视时间（223.6±93.6对92.3±39.7秒；P <.001）和手术时间（154.0±81.0对119.7±48.7分钟；P =.004）显著更低。
结论
术中导航不仅提高了椎弓根螺钉置入的准确性，还允许相对于椎弓根宽度置入更大的螺钉，这可能具有生物力学优势。值得注意的是，与其他研究相反，与荧光透视引导相比，使用导航并未增加患者的辐射暴露或手术时间。
