Cervical pedicle screws - Comparative accuracy of two insertion techniques
Cervical pedicle screws - Comparative accuracy of two insertion techniques
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DOI：
10.1097/00007632-200010150-00022
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发表时间：
2000-10-15
期刊：
影响因子：
3
通讯作者：
Heller, JG
中科院分区：
文献类型：
--
作者：
Ludwig, SC;Kowalski, JM;Heller, JG
研究设计。独立评估装置植入方法的影像学和解剖学比较。目的：比较两种颈椎椎弓根螺钉置入技术的相对准确性。背景资料摘要。为了确定颈椎椎弓根螺钉置入的解剖风险，图像引导立体定向技术在体外被证明优于其他一些方法。同时，Abumi的钉入技术在体内的经验很少有临床上相关的钉位错位病例。目前的图像引导技术与Abumi的透视辅助技术之间没有直接的比较。方法：采用3.5 mm螺钉固定人尸体颈椎椎弓根（c3 ~ c7），两种方法任选一种。通过计算机断层扫描（CT）和解剖解剖独立评估皮质完整性和潜在的神经血管损伤。如果螺钉侵犯任何重要结构，则认为皮质破裂是“严重的”。如果螺钉的任何部分侵犯了椎弓根皮质，但没有重要结构有损伤的危险，则该违反被归类为“非关键”。在第一组（StealthStation; Sofamor-Danek, Memphis， TN）中，82%的螺钉被放置在椎弓根内，18%的螺钉有严重断裂。在第二组（Abumi技术）中，88%的螺钉放置在椎弓根内，12%的螺钉有严重断裂。各组间差异无统计学意义（P=0.59）。考虑到椎弓根的尺寸和置入的安全性，我们确定了4.5 mm的临界椎弓根直径，小于4.5 mm可能发生临界断裂，大于4.5 mm则更有可能安全置入螺钉。各组中最常见的结构损伤是椎动脉。与Abumi的技术相比，使用计算机辅助图像引导系统并没有提高放置椎弓根螺钉的安全性或准确性。如果插入直径小于4.5 mm的椎弓根，这两种技术都有明显的损伤关键结构的风险。在实验室条件下，直径大于4.5 mm的椎弓根通过任何一种技术安全检测的可能性都要大得多。这些数据表明，颈椎椎弓根螺钉置入是可行的，但应保留在有明确适应症和合适椎弓根形态的特定情况下。
Study Design. Independently assessed radiographic and anatomic comparison of device implantation methods.Objectives, To compare the relative accuracy of two techniques of inserting cervical pedicle screws.Summary of Background Data. In an attempt to define the anatomic risks of cervical pedicle screw insertion, image-guided stereotactic technology was shown to be superior to some other methods in vitro. Meanwhile,:in vivo experience with Abumi's technique of screw insertion has had few clinically relevant instances of screw malposition. There has been no direct comparison between current image-guided technology and Abumi's fluoroscopically assisted technique.Methods, The pedicles (C3-C7) of human cadaveric cervical spines were instrumented with 3.5-mm screws with either of two techniques. Cortical integrity and potential neurovascular injury were independently assessed by computed tomographic (CT) scans and anatomic dissection. A cortical breach was considered "critical" if the screw encroached on any vital structure. If any part of the screw violated the cortex of the pedicle but no vital structure was at risk for injury, the breach was classified as "noncritical."Results. In Group I (StealthStation; Sofamor-Danek, Memphis, TN), 82% of screws were placed in the pedicle, and 18% had a critical breach. In Group II (Abumi technique), 88% of screws were placed in the pedicle, and 12% had a critical breach. No statistically significant differences were demonstrated between each group (P=0.59). Regarding pedicle dimensions and safety of insertion, a critical pedicle diameter of 4.5 mm was determined to be the size below which a critical breach was likely, but above which there was a significantly greater likelihood for safe screw placement, The most common structure injured in each group was the vertebral artery.Conclusions. The use of a computer-assisted image guidance system did not enhance safety or accuracy in placing pedicle screws compared with Abumi's technique. Both techniques have a noteworthy risk of injuring a critical structure if inserted into the pedicles with a diameter of less than 4.5 mm. Under laboratory conditions, pedicles with a diameter of more than 4.5 mm have a significantly greater likelihood of being safely instrumented by either technique. These data indicate that cervical pedicle screw placement is feasible, but it should be reserved for selected circumstances with clear indications and in the presence of suitable pedicle morphology.