Kampkuiper Nick, Abkar Asal, Nellensteijn Jorm, Brusse-Keizer Marjolein, Tuijthof Gabriëlle, Koenrades Maaike, Schröder Femke
Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands.
Medical 3D lab, Medisch Spectrum Twente, Enschede, the Netherlands.
Brain Spine. 2025 Jul 22;5:104334. doi: 10.1016/j.bas.2025.104334. eCollection 2025.
Sacroiliac (SI) dysfunction causes of up to 30 % of lower back pain. When conservative treatment is insufficient, SI joint fusion (SIJF) can be indicated to reduce pain. Due to high anatomical variability, poor visibility during intraoperative 2D fluoroscopic imaging, and the absence of 3D spatial information, placing the implant in a stable configuration without damaging critical structures is challenging. To improve patient outcomes, a virtual surgical planning (VSP) method using simulated fluoroscopic images has been developed.
What is the effect of VSP on patient outcomes, including complications, pain scores, satisfaction scores, and Oswestry Disability Index (ODI) scores?
This retrospective case-control study compared procedures performed with VSP to those conducted prior to its implementation. Data were collected from the medical records, Numeric Rating Scale (NRS) questions, and patient reported outcome measures (PROMs). All postoperative CT scans were assessed on implant placement (mal)positioning and fractures. Malposition complications were categorized as severe malposition and suboptimal implant placement.
Seventy-eight procedures were included, 43 in the VSP group and 35 in the conventional group. Severe malposition complications reduced from 9 % to 0 % after VSP was implemented. Suboptimal implant placement reduced from 46 % to 9 % of the interventions. Sacral fractures reduced from 37 % to 14 %. All other primary outcome measures did not show a significant difference between the groups.
VSP in SIJF reduced implant malpositioning and sacral fractures. This can lead to better patient outcomes. A larger multicenter study is needed to explore the broader impact of VSP on SIJF.
骶髂关节功能障碍导致高达30%的下背部疼痛。当保守治疗无效时，可考虑进行骶髂关节融合术（SIJF）以减轻疼痛。由于解剖变异大、术中二维透视成像时视野不佳以及缺乏三维空间信息，在不损伤关键结构的情况下将植入物放置在稳定的位置具有挑战性。为改善患者预后，已开发出一种使用模拟透视图像的虚拟手术规划（VSP）方法。
VSP对患者预后的影响如何，包括并发症、疼痛评分、满意度评分和Oswestry功能障碍指数（ODI）评分？
这项回顾性病例对照研究将采用VSP进行的手术与实施VSP之前进行的手术进行了比较。数据从医疗记录、数字评分量表（NRS）问题以及患者报告的结局指标（PROMs）中收集。所有术后CT扫描均评估植入物的放置（错）位置和骨折情况。位置不当并发症分为严重位置不当和植入物放置欠佳。
共纳入78例手术，VSP组43例，传统组35例。实施VSP后，严重位置不当并发症从9%降至0%。植入物放置欠佳在干预中从46%降至9%。骶骨骨折从37%降至14%。所有其他主要结局指标在两组之间未显示出显著差异。
SIJF中的VSP减少了植入物位置不当和骶骨骨折。这可带来更好的患者预后。需要开展更大规模的多中心研究来探索VSP对SIJF的更广泛影响。
