OMURGA CERRAHİSİNDE SERBEST EL TEKNİĞİ VE ÜÇ BOYUTLU BİLGİSAYARLI TOMOGRAFİ DESTEKLİ NAVİGASYON SİSTEMİYLE YERLEŞTİRİLEN PEDİKÜL VİDALARININ YÖNELİM DOĞRULUĞUNUN KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA
Abstract
Amaç: Spinal cerrahide kullanılan pedikül vida yerleştirme tekniklerinden serbest el tekniği ve üç boyutlu bilgisayarlı tomografi (3D-BT) destekli navigasyon tekniği, vida yerleştirme ve güvenilirlik açısından karşılaştırıldı. Gereç ve Yöntem: Pedikül vidası ile spinal enstrümantasyon uygulanan 73 spinal deformiteli hastanın toplam 1664 vidası çalışmada değerlendirildi. Serbest el tekniği grubunda 40 hasta ve 3D-BT destekli navigasyon tekniği grubunda 33 hasta vardı. Pedikül vidalarının tüm hastalarda yerleştirilmesi ve güvenilirliği, ameliyat sonrası dönemde çekilen BT görüntüleri kullanılarak Gertzbein-Robbins sınıflaması kullanılarak değerlendirildi. Bulgular: Yaş, vücut kitle indeksi (VKİ), cinsiyet (kadın veya erkek) ve deformite (skolyoz veya kifoz) açısından gruplar arası anlamlı fark bulunmadı (p>0,05). Pedikül vidaları transvers penetrasyon açısından değerlendirildiğinde, 3D-BT destekli navigasyon tekniğinde Grade A (%89,6), serbest el tekniğinde Grade A (%76,5) olarak belirlendi. 3D-BT destekli navigasyon tekniği trasvers penetrasyon açısından istatistiksel olarak daha güvenilir tespit edildi (p<0,001). Pedikül vidaları anterior penetrasyon açısından değerlendirildiğinde, hem 3D-BT yardımlı navigasyon tekniğinde Grade A (%92,5) ve serbest el tekniğine Grade A (%82,9) olarak belirlendi. 3D-BT yardımlı navigasyon tekniği anterior penetrasyon açısından istatistiksel olarak daha güvenilir tespit edildi (p<0,001). Sonuç: Çalışmamızın sonuçlarına göre, omurga deformitelerini içeren ameliyatlarda pedikül vidası yerleştirmede 3D-BT destekli navigasyon tekniği serbest el tekniği ile karşılaştırıldığında daha güvenilirdir.
References
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COMPARING THE TRAJECTORY ACCURACY OF PEDICLE SCREWS PLACED WITH A FREE-HAND TECHNIQUE AND A THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-ASSISTED NAVIGATION SYSTEM IN SPINE SURGERY: A RETROSPECTIVE STUDY
Abstract
Objective: We evaluated a free-hand technique and a three-dimensional computerized tomography (3D-CT)-assisted navigation technique, which are pedicle screw placement techniques used in spinal surgery, regarding screw placement and reliability. Materials and Methods: A total of 1664 screws in 73 patients with spinal deformities who underwent spinal instrumentation using pedicle screws were evaluated in this study. Forty patients were in the free-hand technique group, and 33 patients were in the 3D-CT-assisted navigation technique group. The placement and reliability of pedicle screws in all patients were evaluated using the Gertzbein–Robbins classification using CT images taken in the postoperative period. Result: There were no significant differences found regarding age, body mass index (BMI), sex (female or male), or deformity (scoliosis or kyphosis) (p>0.05). When the pedicle screws were evaluated in terms of transverse penetration, the 3D-CT-assisted navigation technique was determined Grade A (89.6%), as was the free-hand technique (76.5%), but the 3D-CT-assisted navigation technique was statistically more reliable (p<0.001). When the pedicle screws were evaluated in terms of anterior penetration, both the 3D-CT-assisted navigation technique (92.5%) and the free-hand technique (82.9%) were determined Grade A, but the 3D-CT-assisted navigation technique was statistically more reliable (p<0.001). Conclusion: According to our study’s results, the 3D-CT-assisted navigation technique is more reliable than the free-hand technique in surgeries involving spine deformities for pedicle screw insertion.
References
- 1. Serhan H, Kuhn M. The history of spinal deformity. Ann Orthop Rheumatol 2016;4(3):1072. [CrossRef] google scholar
- 2. Harrington PR. Treatment of scoliosis. Correction and internal fixation by spinal instrumentation, J Bone Joint Surg Am 1962;44-A:591-610. [CrossRef] google scholar
- 3. Perna F, Borghi R, Pilla F, Stefanini N, Mazzotti A, Chehrassan M. Pedicle screw insertion techniques: an update and review of the literature. Musculoskelet Surg 2016;100(3):165-9. [CrossRef] google scholar
- 4. Ughwanogho E, Patel NM, Baldwin KD, Sampson NR, Flynn JM. Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976) 2012;37(8):E473-8. [CrossRef] google scholar
- 5. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976) 2007;32(3):E111-20. [CrossRef] google scholar
- 6. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 1990;15(1):11-4. [CrossRef] google scholar
- 7. Farrokhi MR, Kazemi AP, Eftekharian HR, Akbari K, Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial. J Neurosurg Anesthesiol 2011;23(4):290-6. [CrossRef] google scholar
- 8. Barney LF. Scoliosis and kyphosis. In: Canale ST, Beaty JH, editors. Campbell’s Operative Orthopaedics 11. Edition, Philadelphia:Mosby 2008.p1944-5. google scholar
- 9. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 1986;(203):7-17. [CrossRef] google scholar
- 10. Urbanski W, Jurasz W, Wolanczyk M, Kulej M, Morasiewicz P, Dragan SL, et al. Increased radiation but no benefits in pedicle screw accuracy with navigation versus a freehand technique in scoliosis surgery. Clin Orthop 2018;476(5):1020-27. [CrossRef] google scholar
- 11. Jin M, Liu Z, Liu X, Yan H, Han X, Qiu Y, et al. Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique. Eur Spine J 2016;25(6):1729-37. [CrossRef] google scholar
- 12. Zhao Z, Liu Z, Hu Z, Tseng C, Li J, Pan W, et al. Improved accuracy of screw implantation could decrease the incidenceof post-operative hydrothorax? O-arm navigation vs. free-handin thoracic spinal deformity correction surgery. Int Orthop 2018;42(9):2141-6. [CrossRef] google scholar
- 13. Qiao J, Zhu F, Xu L, Liu Z, Sun X, Qian B, et al. Accuracy of pedicle screw placement inpatients with Marfan syndrome. BMC Musculoskelet Disord 2017;18(1):123. [CrossRef] google scholar
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | RESEARCH |
| Authors | |
| Publication Date | March 30, 2023 |
| Submission Date | November 3, 2022 |
| Published in Issue | Year 2023 Volume: 86 Issue: 2 |
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