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首页> 外文期刊>Neurosurgery >Reliability of three-dimensional fluoroscopy for detecting pedicle screw violations in the thoracic and lumbar spine.
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Reliability of three-dimensional fluoroscopy for detecting pedicle screw violations in the thoracic and lumbar spine.

机译：三维荧光透视在检测胸椎和腰椎椎弓根螺钉侵犯方面的可靠性。

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OBJECTIVE: Thoracic and lumbar pedicle screws have become popular because of their biomechanical superiority over other methods of spinal fixation. However, the safety and efficacy of transpedicular screws depend on their proper placement. Recent advances in imaging have resulted in the ability to acquire three-dimensional (3-D) axial images of the spine during surgery, and this study was undertaken to assess the reliability of this technology to detect pedicle violations. METHODS: Pedicle screws were placed in six human cadaver spines from T1 to S1 using standard techniques. Intentional pedicle violations were created in 74 of 216 pedicles, and violations were graded on a four-point scale (range, 0-3). Radiographic images were then obtained using a conventional spiral computed tomographic scanner and the Siremobil Iso-C 3D (Siemens Medical Solutions, Erlangen, Germany) 3-D fluoroscopy unit. An independent neuroradiologist then graded pedicle violations as ascertained by the two imaging modalities. RESULTS: Using direct inspection of the pedicles as the "gold standard," the overall sensitivity and specificity for detecting pedicle violations were 0.716 and 0.789, respectively, with 3-D fluoroscopy. The overall sensitivity and specificity for detecting pedicle violations were 0.608 and 0.937, respectively, with conventional computed tomography. All Grade 2 pedicle violations were detected in the thoracic spine by both modalities, and all Grade 3 violations were detected by both modalities. CONCLUSION: Axial images obtained with 3-D fluoroscopy demonstrate a higher sensitivity but lower specificity than conventional computed tomographic scanning for assessing pedicle violations. By providing real-time intraoperative imaging, 3-D fluoroscopy may enhance the safety of thoracic transpedicular instrumentation.
机译：目的：胸椎和腰椎椎弓根螺钉比其他脊柱固定方法具有生物力学优越性，因此广受欢迎。但是，经椎弓根螺钉的安全性和有效性取决于其正确放置的位置。影像学的最新进展使得能够在手术过程中获取脊柱的三维（3-D）轴向图像，并且本研究旨在评估该技术检测椎弓根侵犯的可靠性。方法：使用标准技术将椎弓根螺钉放置在从T1到S1的六个人体尸体棘中。在216个椎弓根中有74个发生了故意的椎弓根侵犯，并以四分制（0-3）进行评分。然后使用常规的螺旋计算机断层扫描仪和Siremobil Iso-C 3D（Siemens Medical Solutions，Erlangen，德国）3-D荧光透视仪获得放射线图像。然后由一名独立的神经放射科医生对两种影像学方法确定的椎弓根侵犯进行分级。结果：使用直接检查椎弓根作为“金标准”，使用3D透视检查法检测椎弓根违规的总灵敏度和特异性分别为0.716和0.789。使用常规计算机断层扫描技术，检测椎弓根侵犯的总体敏感性和特异性分别为0.608和0.937。两种方式均在胸椎中检测到所有2级椎弓根侵犯，并且两种方式均检测到所有3级椎弓根侵犯。结论：与传统的计算机X线断层扫描评估椎弓根侵犯情况相比，通过3-D透视获得的轴向图像显示出更高的灵敏度，但特异性更低。通过提供实时的术中影像，3-D透视可以提高胸椎椎弓根器械的安全性。

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