Bullert Benno, Mandelka Eric, Gruetzner Paul A, Vetter Sven Y, Gierse Jula
BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery at Heidelberg University, Ludwigshafen, Germany.
Brain Spine. 2025 Aug 27;5:104395. doi: 10.1016/j.bas.2025.104395. eCollection 2025.
Posterior fixation with pedicle screws (PS) is a standard procedure in spine surgery. While 3D navigation enhances accuracy and minimizes radiation exposure, the high technical demands and costs typically restrict its use to specialized centers. A potential alternative is markerless 2D/3D image guidance, which enables precise 3D guidance using a standard 2D C-arm.
This experimental study aims to determine whether 2D/3D image guidance enhances accuracy, speed, and radiologic parameters in thoracic and lumbar PS placement compared to 2D fluoroscopy.
This experimental study used radiopaque artificial spine models to compare posterior PS placement between 2D/3D image guidance and 2D fluoroscopy. Three surgeons with different experiences in spine surgery placed 120 PS in total. Two raters assessed accuracy using the Gertzbein-Robbins grading system (GRS).
K-wire placement accuracy was higher with 2D/3D image guidance (). PS placement accuracy (GRS A/B) was significantly higher with 2D/3D image guidance (96.7 %) than with 2D fluoroscopy (80.0 %, ). Average PS insertion time was longer with 2D/3D image guidance (7.12 ± 2.42 min) than with 2D fluoroscopy (2.89 ± 1.29 min, ).
Markerless 2D/3D image guidance significantly enhances the accuracy of PS placement compared to 2D fluoroscopy, although it requires more time for each placement. This system has the potential to improve precision in minimally invasive spine surgery, especially in settings without access to advanced 3D navigation systems. However, the results are based on artificial bone models and limited user experience, which may reduce their generalizability to clinical practice.
椎弓根螺钉后路固定术是脊柱外科的标准手术。虽然三维导航提高了准确性并减少了辐射暴露，但高技术要求和成本通常将其使用限制在专业中心。一种潜在的替代方法是无标记二维/三维图像引导，它能够使用标准二维C型臂实现精确的三维引导。
本实验研究旨在确定与二维荧光透视法相比，二维/三维图像引导是否能提高胸腰椎椎弓根螺钉置入的准确性、速度和放射学参数。
本实验研究使用不透射线的人工脊柱模型比较二维/三维图像引导和二维荧光透视法下的后路椎弓根螺钉置入。三位具有不同脊柱手术经验的外科医生共置入120枚椎弓根螺钉。两名评估者使用格茨贝恩-罗宾斯分级系统（GRS）评估准确性。
二维/三维图像引导下克氏针置入准确性更高（）。二维/三维图像引导下椎弓根螺钉置入准确性（GRS A/B）显著高于二维荧光透视法（96.7%）（80.0%，）。二维/三维图像引导下平均椎弓根螺钉插入时间（7.12±2.42分钟）长于二维荧光透视法（2.89±1.29分钟，）。
与二维荧光透视法相比，无标记二维/三维图像引导显著提高了椎弓根螺钉置入的准确性，尽管每次置入需要更多时间。该系统有可能提高微创脊柱手术的精度，特别是在无法使用先进三维导航系统的情况下。然而，结果基于人工骨模型和有限的用户经验，这可能会降低其在临床实践中的普遍性。
