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首页> 外文期刊>Neurosurgical focus >Image-guided navigation and video-assisted thoracoscopic spine surgery: The second generation
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Image-guided navigation and video-assisted thoracoscopic spine surgery: The second generation

机译：图像引导导航和视频辅助胸镜脊柱外科：第二代

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Object: Video-assisted thoracoscopic surgery (VATS) has evolved for treatment of a variety of spinal disorders. Early incorporation with image-guided surgery (IGS) was challenged due to reproducibility and adaptability, limiting the procedure's acceptance. In the present study, the authors report their experience with second-generation IGS and VATS technologies for anterior thoracic minimally invasive spinal (MIS) procedures. Methods: The surgical procedure is described in detail including operating room set-up, patient positioning (a lateral decubitus position), placement of the spinal reference frame and portal, radiographic localization, registration, surgical instruments, and the image-guided thoracoscopic discectomy. Results: Combined IGS and VATS procedures were successfully performed and assisted in anatomical localization in 14 patients. The mean patient age was 59 years (range 32-73 years). Disc herniation pathology represented the most common indication for surgery (n = 8 patients); intrathoracic spinal tumors were present in 4 patients and the remaining patients had infection and ossification of the posterior longitudinal ligament. All patients required chest tube drainage postoperatively, and all but 1 patient had drainage discontinued the following day. The only complication was a seroma that was presumed to be due to steroid therapy for postoperative weakness. At the final follow-up, 11 of the patients were improved neurologically, 2 patients had baseline neurological status, and the 1 patient with postoperative weakness was able to ambulate, albeit with an assistive device. The evolution of thoracoscopic surgical procedures occurring over 20 years is presented, including their limitations. The combination of VATS and IGS technologies is discussed including their safety and the importance of 3D imaging. In cases of large open thoracotomy procedures, surgeries require difficult, extensive, and invasive access through the chest cavity; using a MIS procedure can potentially eliminate many of the complications and morbidities associated with large open procedures. The authors report their experience with thoracic spinal surgeries that involved MIS procedures and the new technologies. Conclusions: The most significant advance in IGS procedures has resulted from intraoperative CT scanning and automatic registration with the IGS workstation. Image guidance can be used in conjunction with VATS techniques for thoracic discectomy, spinal tumors, infection, and ossification of the posterior longitudinal ligament. The authors' initial experience has revealed this technique to be useful and potentially applicable to other MIS procedures.
机译：目的：视频辅助胸腔镜手术（VALS）已经进化，用于治疗各种脊髓障碍。由于可重复性和适应性，利用图像引导的手术（IGS）提前注册挑战，限制了程序的验收。在本研究中，作者报告了他们对前胸部微创脊柱（MIS）程序的第二代IGS和VATS技术的经验。方法：详细描述了外科手术，包括手术室设置，患者定位（横向褥疮位置），放置脊柱参考框架和门户，放射线定位，登记，手术器械和图像引导的胸腔镜片切除术。结果：合并IGS和VATS程序在14名患者中成功进行并辅助解剖分析。平均患者年龄为59岁（范围32-73岁）。椎间盘突出病理学代表了手术中最常见的迹象（n = 8名患者）; 4例患者中存在胃系膜脊柱肿瘤，其余患者具有后纵韧带的感染和骨化。所有患者术后需要胸管引流，除了1例患者的所有患者都会排出第二天。唯一的并发症是血清瘤被认为是由于类固醇治疗术后弱点。在最终随访中，11名患者的神经学上，2名患者具有基线神经状态，并且术后虚弱的1例患者能够携带辅助装置。介绍了20年超过20年的胸腔镜手术手术的演变，包括它们的局限性。讨论了VATS和IGS技术的组合，包括它们的安全性和3D成像的重要性。在较大的开放式胸廓切开术手术的情况下，手术需要困难，广泛，侵入式进入胸腔;使用MIS程序可能会消除与大型开放程序相关的许多并发症和生命性。作者向涉及MIS程序和新技术的胸椎间身手术报告了他们的经验。结论：IGS程序中最显着的进步是由于术中CT扫描和与IGS工作站的自动注册产生的。图像引导可与胸椎切除术，脊柱肿瘤，感染和后纵韧带的骨化的VATS技术结合使用。作者的初步经验揭示了这种技术有用，可能适用于其他MIS程序。

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