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Intraoperative computed tomography-guided navigation versus fluoroscopy for single-position surgery after lateral lumbar interbody fusion
Journal of Clinical Neuroscience ( IF 1.9 ) Pub Date : 2021-09-13 , DOI: 10.1016/j.jocn.2021.08.023
Akihiko Hiyama 1 , Hiroyuki Katoh 1 , Satoshi Nomura 1 , Daisuke Sakai 1 , Masahiko Watanabe 1
Affiliation  

There are no reports comparing fluoroscopy and intraoperative computed tomography (CT) navigation in lateral single-position surgery (SPS) in terms of surgical outcomes or implant-related complications. Therefore, the purpose of this study was to use radiological evaluation to compare the incidence of instrument-related complications in SPS of lateral lumbar interbody fusion (LLIF) using fluoroscopy with that using CT navigation techniques. We evaluated 99 patients who underwent lateral SPS. Twenty-six patients had a percutaneous pedicle screw (PPS) inserted under fluoroscopy (SPS-C group), and 73 patients had a PPS inserted under intraoperative CT navigation (SPS-O group). Average operation time was shorter in the SPS-C group than in the SPS-O group (88.4 ± 24.4 min versus 111.9 ± 35.3 min, respectively, P = 0.003). However, there was no significant difference between the two groups in postoperative thigh symptoms or reoperation rate. The screw insertion angle of the SPS-C group was smaller than that of the SPS-O group, but there was no significant difference in the rate of screw misplacement (4.6% versus 3.4%, respectively, P = 0.556). By contrast, facet joint violation (FJV) was significantly lower in the SPS-O group than in the SPS-C group (8.4% versus 21.3%, respectively, P < 0.001). While fluoroscopy was superior to intraoperative CT navigation in terms of mean surgery time, there was no significant difference in the accuracy of PPS insertion between fluoroscopy and intraoperative CT navigation. The advantage of intraoperative CT navigation over fluoroscopy is that it significantly decreases the occurrence of FJV in SPS.



中文翻译:

术中计算机断层扫描引导导航与透视在腰椎外侧椎间融合术后单体位手术中的比较

没有报告在手术结果或植入物相关并发症方面比较横向单位手术 (SPS) 中的透视和术中计算机断层扫描 (CT) 导航。因此,本研究的目的是使用放射学评估来比较使用透视与使用 CT 导航技术进行的侧腰椎间融合术 (LLIF) 的 SPS 中器械相关并发症的发生率。我们评估了 99 名接受侧向 SPS 的患者。26例患者在透视下置入经皮椎弓根螺钉(PPS)(SPS-C组),73例患者在术中CT导航下置入PPS(SPS-O组)。SPS-C 组的平均手术时间短于 SPS-O 组(​​分别为 88.4 ± 24.4 分钟和 111.9 ± 35.3 分钟,P = 0.003)。但两组术后大腿症状或再手术率无显着差异。SPS-C组的螺钉插入角度小于SPS-O组,但螺钉错位率无显着差异(分别为4.6%和3.4%,P  =0.556)。相比之下,SPS-O 组的小关节侵犯 (FJV) 显着低于 SPS-C 组(分别为 8.4% 和 21.3%,P < 0.001)。虽然透视在平均手术时间方面优于术中 CT 导航,但在透视和术中 CT 导航之间 PPS 插入的准确性没有显着差异。术中 CT 导航相对于透视的优势在于它显着降低了 SPS 中 FJV 的发生率。

更新日期:2021-09-13
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