Purpose

The violation of the cranial adjacent facet is a frequent complication in lumbar instrumentations and can induce local pain and adjacent segment disease. Minimally invasive screw implantation is often stated as risk factor in comparison with open approaches. Percutaneous pedicle screw placement (PPSP) can be performed using single X-ray images (fluoroscopy) or intraoperative 3D navigation. The study compares top-level screws in percutaneous lumbar instrumentations regarding facet violations and screw pedicle position using navigation or fluoroscopy.

Methods

Patients after lumbar PPSP were retrospectively separated according to the intraoperative technique: navigation (NAV) or fluoroscopy (FLUORO). Two blinded investigators graded the top-level screws regarding facet violations and pedicle breach in postoperative CT scans. Subsequent matched cohort analysis was performed for comparable groups.

Results

Evaluating 768 screws, we assessed 70 (9.1%) facet violations. Overall, 186 (24.2%) screws were implanted using navigation. There was no significant difference in the rate of facet violations between both imaging groups (NAV 19/186, 10.2%, FLUORO 51/582, 8.8%, p = 0.55). Totally, 728 (94.8%) of all screws showed a correct pedicle position. Most of the 40 unfavorable pedicle positions were placed by fluoroscopy (NAV 4/186, 2.2%, FLUORO 36/582, 6.6%, p = 0.03). The matched cohorts verified these results (facet violations: NAV 19/186, 10.2%, FLUORO 18/186, 9.7%, p = 0.55; pedicle penetrations: NAV 4/186, 2.2%, FLUORO 12/186, 6.9%, p = 0.04).

Conclusions

Both intraoperative imaging techniques allow lumbar PPSP with low rates of cranial facet violations if the surgeon intends to preserve facet integrity. Navigation was superior concerning accurate pedicle screw position, but could not significantly prevent facet violations.

中文翻译：

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经皮腰椎椎弓根螺钉置入术中的颅小关节损伤：配对分析比较术中3D导航和常规透视检查。

目的

侵犯腰椎邻近面是腰椎器械中的常见并发症，可引起局部疼痛和邻近节段疾病。与开放式手术相比，微创螺钉植入通常被认为是危险因素。可以使用单个X射线图像（荧光检查）或术中3D导航进行经皮椎弓根螺钉置入（PPSP）。这项研究使用导航或透视检查法比较了经皮腰椎器械中最高级的螺钉，以评估小平面侵犯情况和螺钉蒂的位置。

方法

腰部PPSP术后患者根据术中技术进行回顾性分离：导航（NAV）或荧光检查（FLUORO）。两名盲人调查员对术后CT扫描中有关小平面侵犯和椎弓根破坏的顶级螺钉进行了分级。随后对可比组进行了匹配的队列分析。

结果

通过评估768颗螺钉，我们评估了70例（9.1％）刻面违规情况。总体而言，使用导航植入了186个（24.2％）螺钉。两个成像组之间的小平面侵犯率没有显着差异（NAV 19 / 186，10.2％，FLUORO 51 / 582，8.8％，p  = 0.55）。总共728颗（94.8％）螺钉显示出正确的椎弓根位置。40例椎弓根不利位置中的大多数都通过透视检查定位（NAV 4 / 186，2.2％，FLUORO 36 / 582，6.6％，p  = 0.03）。匹配的队列验证了这些结果（违反方面：NAV 19/186，10.2％，FLUORO 18/186，9.7％，p  = 0.55;椎弓根穿透：NAV 4/186，2.2％，FLUORO 12/186，6.9％，p  = 0.04）。

结论

如果外科医生打算保持小面完整性，则两种术中成像技术都可以使腰椎PPSP的颅面小平面侵犯率低。导航在精确的椎弓根螺钉位置方面是优越的，但不能显着防止小平面侵犯。