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Abstract：
OBJECTIVE: We aim to compare radiation exposure and implant-related complications of the freehand (FH) technique versus intraoperative image-guided navigation (IN) for pedicle screw placement in adolescent idiopathic scoliosis (AIS) and estimate associated lifetime attributable cancer risks.
METHODS: A retrospective analysis of prospectively collected data from 40 consecutive AIS patients treated with pedicle screw instrumentation using the FH technique was performed. The dose area product (DAP) and effective dose (ED) were calculated. Screw-related complications were analysed, and the age- and gender-specific lifetime attributable cancer risks were estimated. The results were compared to previously published data on IN used during surgery for AIS.
RESULTS: There were no implant-related complications in our cohort. Implant density was 86.6%. The mean Cobb angle of the main curve was 75.2° (SD ± 17.7) preoperatively and 27.7° (SD ± 10.8) postoperatively. The mean ED of our cohort and published data for the FH technique was significantly lower compared to published data on the IN technique (p < 0.001). The risk for radiogenic cancer for our FH technique AIS cohort was 0.0014% for male patients and 0.0029% for female patients. Corresponding risks for IN were significantly higher (p < 0.001), ranging from 0.0071 to 0.124% and from 0.0144 to 0.253% for male and female patients, respectively.
CONCLUSIONS: The routine use of intraoperative navigation in AIS surgery does not necessarily reduce implant-related complications but may increase radiation exposure to the patient.
METHODS: A retrospective analysis of prospectively collected data from 40 consecutive AIS patients treated with pedicle screw instrumentation using the FH technique was performed. The dose area product (DAP) and effective dose (ED) were calculated. Screw-related complications were analysed, and the age- and gender-specific lifetime attributable cancer risks were estimated. The results were compared to previously published data on IN used during surgery for AIS.
RESULTS: There were no implant-related complications in our cohort. Implant density was 86.6%. The mean Cobb angle of the main curve was 75.2° (SD ± 17.7) preoperatively and 27.7° (SD ± 10.8) postoperatively. The mean ED of our cohort and published data for the FH technique was significantly lower compared to published data on the IN technique (p < 0.001). The risk for radiogenic cancer for our FH technique AIS cohort was 0.0014% for male patients and 0.0029% for female patients. Corresponding risks for IN were significantly higher (p < 0.001), ranging from 0.0071 to 0.124% and from 0.0144 to 0.253% for male and female patients, respectively.
CONCLUSIONS: The routine use of intraoperative navigation in AIS surgery does not necessarily reduce implant-related complications but may increase radiation exposure to the patient.
摘要：
目的：我们旨在比较徒手（FH）技术与术中图像引导导航（IN）技术在青少年特发性脊柱侧凸（AIS）椎弓根螺钉置入中的辐射暴露和植入物相关并发症，并评估相关的终生归因癌症风险。
方法：对使用FH技术的椎弓根螺钉治疗的40例连续AIS患者的前瞻性数据进行回顾性分析。计算剂量面积乘积(DAP)和有效剂量(ED)。分析螺钉相关并发症，并估计了年龄和性别特定的终生归因癌症风险.将结果与先前发表的关于AIS手术过程中使用的IN的数据进行比较。
结果：我们队列中没有植入相关并发症。种植密度为86.6%。主曲线的平均Cobb角在术前为75.2°（SD±17.7），术后为27.7°（SD±10.8）。与已发表的IN技术数据相比，我们的队列和已发表的FH技术数据的平均ED显着降低（p<0.001）。对于我们的FH技术AIS队列，男性患者的放射性癌症风险为0.0014％，女性患者为0.0029％。IN的相应风险显著更高(p<0.001)，男性和女性患者的范围为0.0071至0.124%，0.0144至0.253%，分别。
结论：在AIS手术中常规使用术中导航并不一定能减少植入物相关并发症，但可能会增加患者的辐射暴露。
方法：对使用FH技术的椎弓根螺钉治疗的40例连续AIS患者的前瞻性数据进行回顾性分析。计算剂量面积乘积(DAP)和有效剂量(ED)。分析螺钉相关并发症，并估计了年龄和性别特定的终生归因癌症风险.将结果与先前发表的关于AIS手术过程中使用的IN的数据进行比较。
结果：我们队列中没有植入相关并发症。种植密度为86.6%。主曲线的平均Cobb角在术前为75.2°（SD±17.7），术后为27.7°（SD±10.8）。与已发表的IN技术数据相比，我们的队列和已发表的FH技术数据的平均ED显着降低（p<0.001）。对于我们的FH技术AIS队列，男性患者的放射性癌症风险为0.0014％，女性患者为0.0029％。IN的相应风险显著更高(p<0.001)，男性和女性患者的范围为0.0071至0.124%，0.0144至0.253%，分别。
结论：在AIS手术中常规使用术中导航并不一定能减少植入物相关并发症，但可能会增加患者的辐射暴露。
