Accuracy of Multilevel Registration in Image-Guided Pedicle Screw Insertion for Adolescent Idiopathic Scoliosis
Accuracy of Multilevel Registration in Image-Guided Pedicle Screw Insertion for Adolescent Idiopathic Scoliosis
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DOI：
10.1097/brs.0b013e3181b77f0a
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发表时间：
2010-02-01
期刊：
影响因子：
3
通讯作者：
Kato, Hiroyuki
中科院分区：
文献类型：
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作者：
Takahashi, Jun;Hirabayashi, Hiroki;Kato, Hiroyuki
研究设计。回顾性临床研究。目的。评估青少年特发性脊柱侧凸 (AIS) 背景下图像引导、计算机辅助脊柱手术期间跳过椎弓根螺钉置入的多级配准的准确性。背景数据摘要。最近，计算机化的无框架立体定向图像引导已被用来提高脊柱手术期间椎弓根螺钉放置的准确性和安全性。由于术前成像和手术之间可能存在椎间运动以及患者位置通常存在差异，成像模型和手术暴露的脊柱可能会显着不一致。因此，当前的方案建议在各自的椎弓根螺钉放置之前对每个脊柱水平进行单独配准（单水平配准），这是一个耗时的过程。而且，虽然腰椎的多级配准已有报道，但胸椎的多级配准还没有方法。共有 19 名 AIS 患者（1 名男性和 18 名女性；平均年龄 13.9 岁）接受了跳跃式椎弓根螺钉置入的多级登记。评估的变量包括手术时间、失血量、术前和术后 2 年 Cobb 角、矫正率和术后计算机断层扫描图像的螺钉位置。记录每个病例的每个连续椎骨的点合并后和表面合并后的平均配准误差。结果。平均手术时间为 310 分钟（范围为 168-420 分钟）。平均失血量 1138 克（范围：300-2300 克）。术前和术后2年Cobb角分别为62.4°（43°-100°）和21.6°（9°-42°）。平均矫正率 66.2% (39.7%-84.5%)。使用基于计算机断层扫描的导航系统总共插入了 265 个螺钉。仅 4 个螺钉（1.5%）观察到椎弓根侵犯。无神经血管并发症发生。点合并后，所有情况的平均配准误差为1.69 +/- 0.52 mm，面合并后为0.51 +/- 0.16 mm。结论。多级配准可以减少手术时间，而不影响该技术在 AIS 环境中提供的椎弓根螺钉放置的准确性。
Study Design. Retrospective clinical study.Objective. To assess the accuracy of multilevel registration for skip pedicle screw placement during image-guided, computer-assisted spine surgery, in the setting of adolescent idiopathic scoliosis (AIS).Summary of Background Data. Computerized frameless stereotactic image-guidance has been used recently to improve pedicle screw placement accurately and safety during spine surgery. Because of possible intervertebral motion and usual difference in patients' position between preoperative imaging and surgery, the imaging model and the surgically exposed spine may be significantly discordant. Consequently, current protocols suggested separate registration of each spinal level (single-level registration) before respective pedicle screw placement, a time-consuming process. Moreover, although multilevel registration for lumbar spine has been reported, and that for thoracic spine has not.Methods. A total of 19 patients ( 1 male and 18 females; mean age, 13.9 years) with AIS who underwent multilevel registration for skip pedicle screw placement were included. Variables including surgical time, blood loss, preoperative and 2-year postoperative Cobb angle, correction rate, and postoperative screw position by computed tomography image were evaluated. Mean registration error after point merge and again after surface merge were recorded for each consecutive vertebra of each case.Results. Mean surgical time was 310 minutes ( range, 168-420 min). Mean blood loss 1138 g (range, 300-2300 g). Cobb angle before operation and at 2 years postoperation was 62.4 degrees (43 degrees-100 degrees) and 21.6 degrees (9 degrees-42 degrees), respectively. Mean correction rate 66.2% (39.7%-84.5%). Total 265 screws were inserted with computed tomography-based navigation system. Pedicle violation was observed in only 4 screws (1.5%). No neurovascular complication occurred. After point merge, average Mean registration error of all cases was 1.69 +/- 0.52 mm, and after surface merge was 0.51 +/- 0.16 mm.Conclusion. Multilevel registration may decrease operative time without compromising accuracy of pedicle screw placement afforded by this technique in the setting of AIS.