Utility of a Computer-assisted Rod Bending System to Avoid Pull-out and Loosening of Percutaneous Pedicle Screws
Utility of a Computer-assisted Rod Bending System to Avoid Pull-out and Loosening of Percutaneous Pedicle Screws
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DOI：
10.1097/bsd.0000000000001099
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发表时间：
2021-04-01
影响因子：
1.9
通讯作者：
Haro, Hirotaka
中科院分区：
文献类型：
--
作者：
Ohba, Tetsuro;Ebata, Shigeto;Haro, Hirotaka
研究设计：这是一项对连续患者的回顾性观察研究。目的：比较(1)手动和(2)计算机辅助(CA)弯棒技术对椎弓根螺钉在复位和最终拉紧过程中松动的影响。背景资料总结：我们最近的研究表明，棒复位过程中的螺丝拔出可能是经皮椎弓根螺钉(PPS)术后松动的危险因素，导致术后背部疼痛加剧。我们回顾分析了53例患者的资料，这些患者在术中CT引导下，分别采用传统的手动弯曲棒和CA棒弯曲进行微创腰椎或胸椎稳定手术，并进行了1年的随访。方法：在螺钉置入后即刻和术后获得的轴位CT图像上测量螺钉拔出长度。术后1年通过放射学、临床和CT对螺钉松动和临床结果进行评估。比较两种弯曲方法螺钉拔出和螺钉松动的发生率。结果：手法组共放置360枚椎弓根螺钉，CA组共放置124枚椎弓根螺钉。两组患者的平均年龄、性别、骨密度、平均稳定长度或吸烟习惯没有显著差异。两组之间放置的螺钉的直径、长度和轨迹角(轴向和矢状位)没有显著差异。CA组的螺丝拔出率/长度和松动程度均明显低于手法组。与手法组相比，CA组术后腰背痛有明显改善。结论：CA弯曲术有助于避免术后钢棒复位、螺钉松动时PPS拔出。颈动脉弯曲有助于避免PPS在术后棒复位和螺钉松动时拔出。这一结果可能是导致CA组术后腰痛减轻的一个因素，然而，未来的研究需要调查这种联系。
Study Design:This was a retrospective observational study of a cohort of consecutive patients.Objective:To compare the influence of (1) manual and (2) computer-assisted (CA) rod bending techniques on pedicle screw pull-out resulting in loosening during rod reduction and final tightening.Summary of Background Data:Our recent study showed screw pull-out during rod reduction might be a risk factor for loosening of percutaneous pedicle screws (PPSs) postoperatively, resulting in worse postoperative back pain. We retrospectively analyzed data from 53 consecutive patients who underwent minimally invasive lumbar or thoracic spinal stabilization using intraoperative computed tomography image (CT)-guided navigation with conventional manual rod bending or CA rod bending and were followed up for 1 year.Method:Screw pull-out length was measured on axial CT images obtained immediately after screw insertion and postoperatively. Loosening of screws and clinical outcome were evaluated radiographically, clinically, and by CT 1 year after surgery. The frequencies of screw pull-out and screw loosening between the 2 rod bending techniques were compared. Lumbar pain-related factors for both groups of patients were determined preoperatively and 1 year after surgery.Results:Overall, 360 pedicle screws were placed in the manual group and 124 pedicle screws were placed in the CA group. There was no significant difference in the mean age, sex, bone mineral density, mean stabilized length, or smoking habits of patients between the groups. The diameters, lengths, and trajectory angle (axial and sagittal) of the screws placed were not significantly different between the groups. Screw pull-out rate/length and loosening in the CA group was significantly lower than that in the manual group. Postoperative low back pain improved significantly in the CA group compared with that in the manual group.Conclusion:CA bending is useful to avoid PPS pull-out during rod reduction and screw loosening postoperatively. CA bending is useful to avoid PPS pull-out during rod reduction and screw loosening postoperatively. This result might have been a factor leading to reduced postoperative back pain in the CA group, however, that future studies are need to investigate this association.