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首页> 外文期刊>British journal of neurosurgery >A prospective study on the use of intraoperative computed tomography (iCT) for image-guided placement of thoracic pedicle screws
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A prospective study on the use of intraoperative computed tomography (iCT) for image-guided placement of thoracic pedicle screws

机译：术中计算机体层摄影术（iCT）在胸椎椎弓根螺钉图像引导下定位的前瞻性研究

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Background. Placement of thoracic pedicle screws is a technically demanding procedure. The risk of thoracic pedicle breaches range from 6.5 to 41%. Current image guidance systems consist of computer based systems utilizing preoperative CT scans or 2D/3D intraoperative fluoroscopy. Objective. The aim of this prospective study was to evaluate the clinical feasibility and accuracy of a new intraoperative CT (iCT) based image guidance system for thoracic pedicle screw instrumentation. Methods. We prospectively studied the use of iCT for the first 43 consecutive cases for which thoracic pedicle screws were inserted as part of the instrumentation for spinal fusion between April 2008 and July 2011. In every case, a post-instrumentation intraoperative check CT was done before wound closure to assess accuracy of implant placement. Outcomes were analysed with regards to the incidence of pedicle wall violations detected on intraoperative check CT imaging, and the rate of immediate intraoperative revision of misplaced screws. Pedicle violations were graded according to an established classification system, Results. A total of 261 thoracic pedicle screws (T1-T12) were inserted in 43 patients (age range 13-83). Mean follow-up was 12 months. There were 7 (2.7%) pedicle violations detected on the intraoperative check CT. Out of the seven, three were grade I (<2 mm), two were grade II (2-4 mm) and rest two were grade III (>4 mm) violations. Only four of the screws (1.5%) that breached the pedicle wall by more than 2 mm were immediately revised before wound closure. Conclusion. The iCT based spinal neuronavigation system allowed for highly safe and accurate placement (97.3%) of thoracic pedicle screws in our institution with no neurovascular injury reported.
机译：背景。放置胸椎椎弓根螺钉是一项技术要求很高的过程。胸椎椎弓根破裂的风险为6.5％至41％。当前的图像引导系统由基于计算机的系统组成，这些系统利用术前CT扫描或2D / 3D术中透视检查。目的。这项前瞻性研究的目的是评估用于胸椎椎弓根螺钉器械的新型术中基于CT（iCT）的图像引导系统的临床可行性和准确性。方法。我们对2008年4月至2011年7月之间连续43例行胸椎弓根螺钉置入作为椎弓根融合器械的病例的iCT进行了研究。在每种情况下，均在创伤前进行器械后术中检查CT闭合以评估植入物放置的准确性。分析了在术中检查CT成像中发现的椎弓根壁侵犯的发生率，以及术中立即放错螺钉的发生率。根据建立的分类系统，结果对椎弓根侵犯进行分级。总共261例胸椎椎弓根螺钉（T1-T12）插入了43例患者（年龄范围13-83）。平均随访时间为12个月。术中检查CT发现7例（2.7％）椎弓根侵犯。在这七个中，三个是I级（<2毫米），两个是II级（2-4毫米），其余两个是III级（> 4毫米）违规。在闭合伤口之前，只有四颗螺钉（1.5％）突破了椎弓根壁超过2mm。结论。基于iCT的脊柱神经导航系统允许在我们机构中高度安全，准确地放置（97.3％）胸椎椎弓根螺钉，而没有神经血管损伤的报道。

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