Comparative Cohort Study of Percutaneous Pedicle Screw Implantation without Versus with Navigation in Patients Undergoing Surgery for Degenerative Lumbar Disc Disease
| Autor: | Christian Raftopoulos, Julien Pierrard, Edward Fomekong |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty Percutaneous Lumbar vertebrae Intervertebral Disc Degeneration Cohort Studies Stereotaxic Techniques 03 medical and health sciences 0302 clinical medicine Lumbar Imaging Three-Dimensional Pedicle Screws Medicine Fluoroscopy Humans Diskectomy Percutaneous 030212 general & internal medicine Aged Lumbar Vertebrae medicine.diagnostic_test business.industry Middle Aged medicine.disease Surgery medicine.anatomical_structure Surgery Computer-Assisted Cohort Stereotaxic technique Female Neurology (clinical) business 030217 neurology & neurosurgery Lumbar disc disease Cohort study |
| Zdroj: | World neurosurgery. 111 |
| ISSN: | 1878-8769 |
| Popis: | Background The major limitation of computer-based three-dimensional fluoroscopy is increased radiation exposure of patients and operating room staff. Combining spine navigation with intraoperative three-dimensional fluoroscopy (io3DF) can likely overcome this shortcoming, while increasing pedicle screw accuracy rate. We compared data from a cohort of patients undergoing lumbar percutaneous pedicle screw placement using io3DF alone or in combination with spine navigation. Methods This study consisted of 168 patients who underwent percutaneous pedicle screw implantation between 2009 and 2016. The primary endpoint was to compare pedicle screw accuracy between the 2 groups. Secondary endpoints were to compare radiation exposure of patients and operating room staff, duration of surgery, and postoperative complications. Results In group 1, 438 screws were placed without navigation guidance; in group 2, 276 screws were placed with spine navigation. Mean patient age in both groups was 58.6 ± 14.1 years. The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. Average radiation dose per patient was significantly larger in group 1 (571.9 mGym 2 ) than in group 2 (365.6 mGym 2 ) ( P = 0.000088). Surgery duration and complication rate were not significantly different between the 2 groups ( P > 0.05). Conclusions io3DF with spine navigation minimized radiation exposure of patients and operating room staff and provided an excellent percutaneous pedicle screw accuracy rate with no permanent complications compared with io3DF alone. This setup is recommended, especially for patients with a complex degenerative spine condition. |
| Databáze: | OpenAIRE |
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