PDF(Pubmed)
Abstract：
Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a transthoracic transpleural approach at our Department using iCT and microscope-based AR were included in the study. Results: Six consecutive patients (five female, median age 53.2 ± 6.4 years) with calcified herniated thoracic discs (two patients Th 10-11 level, two patients Th 7-8, one patient Th 9-10, one patient Th 11-12) were included in this case series. Indication for surgery included evidence of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of >50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic registration was performed following the placement of the reference array, with a high registration accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 ± 156 min. The use of AR improved orientation in the operative field for identification, and tailored the resection of the herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the complete resection in five patients and incomplete resection of the herniated disc in one patient. In one patient, complications occurred, such as postoperative hematoma, and wound healing deficit occurred. Mean follow-up was 22.9 ± 16.5 months. Five patients improved following surgery, and one patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR significantly improved orientation in the operative field and facilitated safe resection of these lesions.
摘要：
背景和目的：本研究的目的是介绍我们在侧卧位经胸入路手术治疗钙化性胸椎间盘突出症的经验，并使用术中计算机断层扫描（iCT）和增强现实（AR）。材料和方法：本研究包括所有在我们部门使用iCT和基于显微镜的AR通过经胸胸膜入路接受钙化胸椎间盘手术的患者。结果：连续6例患者（5例女性，中位年龄53.2±6.4岁）伴有钙化性胸椎椎间盘突出（两名患者Th10-11级，该病例系列包括两名患者Th7-8，一名患者Th9-10，一名患者Th11-12）。手术适应症包括磁共振成像（MRI）和CT上钙化的胸椎椎间盘，椎管狭窄直径>50％，顽固性疼痛,和神经缺陷，以及脊髓病的MRI征象.五名患者有轻瘫和共济失调，一名患者没有赤字。所有手术均通过经胸胸膜入路在侧卧位进行（左侧五个）。在放置参考阵列后进行自动配准的CT，具有很高的配准精度。使用基于显微镜的AR，具有感兴趣的分段结构，如椎体，光盘空间,椎间盘突出,还有硬脑膜囊.平均手术时间为277.5±156分钟。在手术领域使用AR改进的定向进行识别，并量身定制了突出椎间盘的切除和硬膜囊的病程鉴定。对照iCT扫描证实5例患者完全切除，1例患者椎间盘突出不完全切除。在一个病人中,并发症发生,如术后血肿，出现伤口愈合缺陷。平均随访时间为22.9±16.5个月。五名患者在手术后有所改善，一名没有赤字的患者保持不变。结论：对钙化性胸椎间盘疾病伴硬膜囊压迫和脊髓病变的患者，通过经胸胸膜入路切除了最佳的手术治疗。基于iCT的配准和基于显微镜的AR的使用显着改善了手术领域的定向，并促进了这些病变的安全切除。
