Pedicle violation and Navigational errors in pedicle screw insertion using the intraoperative O-arm: A preliminary report.
Pedicle violation and Navigational errors in pedicle screw insertion using the intraoperative O-arm: A preliminary report.
复制标题
DOI：
10.1016/j.ijsp.2013.06.002
复制
发表时间：
2013
影响因子：
1.6
通讯作者：
Goulet, Benoit
中科院分区：
文献类型：
--
作者：
Mathew, Jacob E;Mok, Kelvin;Goulet, Benoit
使用计算机辅助椎弓根螺钉置入有一定的优势，因为据报道可以减少椎弓根断裂和临床事件的发生率。基于术前计算机断层成像、二维透视和三维透视的配准方法是最流行的，但每种方法都有其局限性。基于o臂的导航，利用术中获取和配准导航图像，可以克服许多这些缺点。我们开始研究使用我们最近获得的o型臂置入椎弓根螺钉的临床准确性和导航准确性，并提出我们的初步研究结果。前26例连续行L4-5融合术的患者被纳入研究。采用o型臂导航置入椎弓根螺钉。获得术后计算机断层图像并评估椎弓根断裂和前皮质穿孔。将每个螺钉的计划轨迹与术后图像中的实际轨迹进行比较，以评估轴位和矢状面导航精度。共置入104颗螺钉。1颗螺钉（1%）向外侧破坏椎弓根。7颗螺钉（6.7%）出现前外侧皮质无明显穿孔，均发生在L5水平。轴向和矢状面平均导航误差分别为2.3°（±1.7）和3.1°（±2.3）。L4和L5水平的误差无显著性差异。前牙穿孔的发生与轴向导航误差（P = 0.02）相关，而与矢状导航误差无关（P = 0.12）。无与螺钉置入相关的临床事件。使用o型臂引导的椎弓根螺钉插入与椎弓根断裂发生率低（1%）以及矢状面和轴向面导航误差范围小相关。L5椎体前外侧穿孔发生率较高，无任何临床不良事件。尽管需要很高的技术支持，但我们发现o型臂是一种非常有效的工具，可以准确地插入椎弓根螺钉。
Use of computer-assisted insertion of pedicle screws has some advantages owing to the reportedly decreased incidence of pedicle breach and clinical events. Registration-based methods based on preoperative computed tomography imaging, 2D fluoroscopy, and 3D fluoroscopy are the most popular, however each has its limitations. O-arm–based navigation, which uses intraoperative acquisition and registration of navigated images, may overcome many of these disadvantages. We set out to study the clinical accuracy and navigational accuracy for pedicle screw insertion using our recently acquired O-arm and present our preliminary findings. The first 26 patients operated consecutively for L4-5 fusion were included in the study. O-arm–based navigation was used to insert the pedicle screws. Postoperative computed tomography images were acquired and assessed for pedicle breach and anterior cortical perforation. Planned trajectories of each screw were compared with the actual trajectories in the postoperative images to assess navigational accuracy in both axial and sagittal planes. A total of 104 screws were inserted. One screw (1%) breached the pedicle laterally. Nonsignificant anterolateral cortical perforations were noted in 7 screws (6.7%), all of which occurred at L5 level. The mean axial and sagittal navigational error was 2.3° (±1.7) and 3.1° (±2.3), respectively. There were no significant differences in the errors between L4 or L5 level. The occurrence of anterior perforation correlated with the degree of axial (P = .02) but not sagittal (P = .12) navigational error. There were no clinical events related to the screw insertion. Use of O-arm–guided pedicle screw insertion was associated with low incidence of pedicle breach (1%) and a low range of navigational error in both sagittal and axial planes. Anterolateral vertebral body perforation was higher at L5 without any negative clinical events. Despite the high need for technical support, we found that O-arm was a very efficient tool for accurate pedicle screw insertion.