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首页> 外文期刊>Neurosurgical focus >Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation.
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Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation.

机译：微创经皮椎弓根螺钉置入术中CT（O型臂）图像导航的临床和影像学结果。

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Intraoperative CT image-guided navigation (IGN) has been increasingly incorporated into minimally invasive spine surgery (MIS). The vast improvement in image resolution and virtual real-time images with CT-IGN has proven superiority over traditional fluoroscopic techniques. The authors describe their perioperative MIS technique using the O-arm with navigation, and they report their postoperative experience, accuracy results, and technical aspects. A retrospective review of 48 consecutive adult patients undergoing minimally invasive percutaneous posterior spinal fusion with intraoperative CT-IGN between July 2010 and August 2013 at Cedars-Sinai Medical Center was performed. Two surgeons assessed 290 screws in a blinded fashion on intraoperative O-arm images and postoperative CT scans for bony pedicle wall breach. Grade 1 breach was defined to be < 2 mm, Grade 2 breach to be between 2 and 4 mm, and a Grade 3 breach to be > 4 mm. Additionally, anterior vertebral body breach was recorded. Of 290 pedicle screws placed, 280 (96.6%) were in an acceptable position without cortical wall or anterior breach. Of the 10 breaches (3.4%) 5 were lateral (50%), 4 were medial, and 1 was anterior; 90% of breaches were Grade 1-2 and all medial breaches were Grade 1. The one Grade 3 breach was lateral. No vascular or neurological complications were observed intraoperatively, and no significant postoperative complications were noted. The mean clinical follow-up period was 18 months (range 3-39 months). The overall clinical outcomes, measured using the visual analog scale (back pain scores), were improved significantly postoperatively at 3 months compared with preoperatively (visual analog score 6.35 vs 3.57; p < 0.0001). No revision surgery was performed for screw misplacement or neurological deterioration. New CT-IGN with the mobile O-arm scanner has increased the accuracy of pedicle screw/instrumentation placement using MIS techniques. The authors' high (96.6%) accuracy rate in MIS compares favorably with historical published accuracy rates for fluoroscopy-based techniques. Additional advantages of CT-IGN over fluoroscopic imaging methods are lower occupational radiation exposure for the surgical team, reduced need for postoperative imaging, and decreased rates of revision surgery. For now, the authors simply conclude that use of intraoperative CT-IGN is safe and accurate.
机译：术中CT图像引导导航（IGN）已越来越多地纳入微创脊柱外科手术（MIS）中。 CT-IGN大大提高了图像分辨率和虚拟实时图像，已证明优于传统的荧光检查技术。作者描述了使用带导航的O型臂的围手术期MIS技术，并报告了其术后经验，准确性结果和技术方面。回顾性分析了2010年7月至2013年8月在Cedars-Sinai医疗中心接受连续微创经皮后路脊柱融合术术中CT-IGN的48例成年患者。两名外科医生在术中O型臂图像和术后CT扫描中以盲法评估了290颗螺钉，以检查骨蒂的壁是否破裂。 1级缺口定义为<2毫米，2级缺口定义为2至4毫米，3级缺口定义为> 4毫米。另外，记录了椎体前部破裂。在放置的290个椎弓根螺钉中，有280个（96.6％）处于可接受的位置，没有皮质壁或前部裂口。在10次（3.4％）破裂中，有5次是外侧（50％），其中4次是内侧，其中1次是前侧; 90％的违规为1-2级，所有内侧的违规为1级。一个3级的违规为外侧。术中未观察到血管或神经系统并发症，也未发现明显的术后并发症。平均临床随访期为18个月（范围3-39个月）。与术前相比，使用视觉模拟量表（背痛评分）测量的总体临床结局在术后3个月时显着改善（视觉模拟评分6.35 vs 3.57; p <0.0001）。没有因螺钉错位或神经系统恶化而进行翻修手术。带有移动O型臂扫描仪的新型CT-IGN使用MIS技术提高了椎弓根螺钉/器械放置的准确性。作者在MIS中的高准确率（96.6％）与基于荧光透视技术的历史公开准确率相比具有优势。与荧光透视成像方法相比，CT-IGN的其他优点是手术团队的职业辐射照射量更低，术后成像需求减少以及翻修手术率降低。目前，作者仅得出结论，术中CT-IGN的使用是安全且准确的。

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    《Neurosurgical focus》 |2014年第3期|共1页
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  • 中图分类 外科学;
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