Spine Surgery, Ganga Hospital, Coimbatore, India

Tarun Dusad; Vishal Kundnani; Shumayou Dutta; Ankit Patel; Gaurav Mehta; Mahendra Singh

추천

검색

자료유형: 학술저널

저자정보: Tarun Dusad (Bombay Hospital & Medical Research Centre) Vishal Kundnani (Bombay Hospital & Medical Research Centre) Shumayou Dutta (Bombay Hospital & Medical Research Centre) Ankit Patel (Bombay Hospital & Medical Research Centre) Gaurav Mehta (Bombay Hospital & Medical Research Centre) Mahendra Singh (Bombay Hospital & Medical Research Centre)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.12 No.2

발행연도: 2018.1

수록면: 309 - 316 (8page)

이용수

📌

연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

초록· 키워드

오류제보하기

Study Design: Prospective cohort study. Purpose: To compare intraoperative parameters, radiation exposure, and pedicle screw perforation rate in navigation-guided versus non-navigated fluoroscopy-assisted minimal invasive transforaminal lumbar interbody fusion (MIS TLIF). Overview of Literature: The poor reliability of fluoroscopy-guided instrumentation and growing concerns about radiation exposure have led to the development of navigation-guided instrumentation techniques in MIS TLIF. The literature evaluating the efficacy of navigation-guided MIS TLIF is scant. Methods: Eighty-seven patients underwent navigation- or fluoroscopy-guided MIS TLIF for symptomatic lumbar/lumbosacral spondylolisthesis. Demographics, intraoperative parameters (surgical time, blood loss), and radiation exposure (sec/mGy/Gy.cm2 noted from C-arm for comparison only) were recorded. Computed tomography was performed in patients in the navigation and non-navigation groups at postoperative 12 months and reviewed by an independent observer to assess the accuracy of screw placement, perforation incidence, location, grade (Mirza), and critical versus non-critical neurological implications. Results: Twenty-seven patients (male/female, 11/16; L4–L5/L5–S1, 9/18) were operated with navigation-guided MIS TLIF, whereas 60 (male/female, 25/35; L4–L5/L5–S1, 26/34) with conventional fluoroscopy-guided MIS TILF. The use of navigation resulted in reduced fluoroscopy usage (dose area product, 0.47 Gy.cm2 versus 2.93 Gy.cm2), radiation exposure (1.68 mGy versus 10.97 mGy), and fluoroscopy time (46.5 seconds versus 119.08 seconds), with p -values of <0.001. Furthermore, 96.29% (104/108) of pedicle screws in the navigation group were accurately placed (grade 0) (4 breaches, all grade I) compared with 91.67% (220/240) in the non-navigation group (20 breaches, 16 grade I+4 grade II; p =0.114). None of the breaches resulted in a corresponding neurological deficit or required revision. Conclusions: Navigation guidance in MIS TLIF reduced radiation exposure, but the perforation status was not statistically different than that for the fluoroscopy-based technique. Thus, navigation in nondeformity cases is useful for significantly reducing the radiation exposure, but its ability to reduce pedicle screw perforation in nondeformity cases remains to be proven.

참고문헌 (17)

참고문헌 신청

Ravi B / 2011 / Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws / Spine (Phila Pa 1976) 36:84~91

Kosmopoulos V / 2007 / Pedicle screw placement accuracy: a meta-analysis / Spine (Phila Pa 1976) 32:E111~E120

Tian NF / 2009 / Image-guided pedicle screw insertion accuracy: a meta-analysis / Int Orthop 33:895~903

Esses SI / 1993 / Complications associated with the technique of pedicle screw fixation: a selected survey of ABS members / Spine (Phila Pa 1976) 18:2231~2238

Lonstein JE / 1999 / Complications associated with pedicle screws / J Bone Joint Surg Am 81:1519~1528

함께 읽어보면 좋을 논문

논문 유사도에 따라 DBpia 가 추천하는 논문입니다. 함께 보면 좋을 연관 논문을 확인해보세요!