C2椎弓根和pars螺钉需要准确放置,以避免损伤附近的神经血管结构。徒手,透视引导,医学文献中已经描述了基于计算机断层扫描(CT)的导航技术。
本研究旨在比较徒手技术与立体定向导航的安全性和准确性,以放置C2椎弓根和螺钉。
本研究是对后路固定结构治疗的连续患者的回顾性研究。
共有220名连续患者接受了包含C2螺钉或椎弓根螺钉的后路固定结构的治疗。
使用计算机断层扫描成像来评估螺钉放置的准确性。分析术中并发症及术后30天内卒中或死亡的发生率。
在2010年1月1日至2016年8月31日期间,对脊柱外科医生使用包含C2螺钉或椎弓根螺钉的后路固定结构进行了回顾性研究。收集和分析临床和影像学数据。螺钉精度由两名评审员根据以下标准独立进行分级:A级(无违反),B-E级(破裂伴横孔阻塞1%-25%,26%-50%,51%-75%,或76%-100%,分别),和M级(内侧缺口)。螺钉分为可接受(A级和B级)和不可接受(C-E级和M级)。
总共426个C2螺钉或椎弓根螺钉(312个徒手,114导航)被放置在220名患者(160徒手,60导航)。两组之间的并发症相似:三个椎动脉损伤(两个[1%]徒手,一个[2%]导航;p>.99),5人死亡(4[3%]写意,一个[2%]导航;p>.99),导航组中的一个(2%)行程(p=.61)。计算机断层扫描成像可用于182个螺钉(131个徒手,51导航)。在113个徒手螺钉(86%)和34个导航螺钉(67%)中未发生破裂(A级)(p=.006)。徒手组(131个中的123个,94%)比导航组(51个中的42个,82%)更多的螺钉(p=.02)。
术后CT成像患者(43%),对于C2椎弓根或螺钉的放置,徒手技术比基于CT的导航更准确。在这项研究中,两种技术的并发症发生率没有差异。
C2 pedicle and pars screws require accurate placement to avoid injury to nearby neurovascular structures. Freehand, fluoroscopically guided, and computed tomography (CT)-based navigation techniques have been described in the medical literature.
The present study aims to compare the safety and accuracy of the freehand technique versus stereotactic navigation for the placement of C2 pedicle and pars screws.
This study was a retrospective review of consecutive patients treated with posterior fixation constructs.
A total of 220 consecutive patients were treated with posterior fixation constructs containing C2 pars or pedicle screws placed at our institution.
Computed tomography imaging was used to assess the accuracy of screw placement. Intraoperative complications and incidence of stroke or mortality within 30 days of the operation were analyzed.
A retrospective review was conducted of consecutive patients treated with posterior fixation constructs containing C2 pars or pedicle screws placed by spine surgeons between January 1, 2010, and August 31, 2016. Clinical and radiographic data were collected and analyzed. Screw accuracy was graded independently by two reviewers according to the following criteria: grade A (no breach), grades B-E (breach with transverse foramen obstruction of 1%-25%, 26%-50%, 51%-75%, or 76%-100%, respectively), and grade M (medial breach). Screws were divided into acceptable (grades A and B) and unacceptable (grades C-E and M).
A total of 426 C2 pars or pedicle screws (312 freehand, 114 navigated) were placed in 220 patients (160 freehand, 60 navigated). Complications were similar between the groups: three vertebral artery injuries (two [1%] freehand, one [2%] navigated; p>.99), five deaths (four [3%] freehand, one [2%] navigated; p>.99), and one (2%) stroke in the navigated group (p=.61). Computed tomography imaging was available for accuracy grading of 182 screws (131 freehand, 51 navigated). No breaches (grade A) occurred in 113 of the freehand screws (86%) and in 34 of the navigated screws (67%) (p=.006). More screws had acceptable placement in the freehand group (123 of 131, 94%) than in the navigated group (42 of 51, 82%) (p=.02).
In patients with postoperative CT imaging (43%), the freehand technique was found to be more accurate than CT-based navigation for C2 pedicle or pars screw placement. Complication rates did not differ between the two techniques in this study.