Practice Pattern Variations in the Use of Neuromonitoring, Image Guidance, and Robotics for Lumbar Pedicle Screw Placement Based on a Nationwide Neurosurgery Survey.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-11-01 DOI:10.1016/j.wneu.2024.10.017

Helen Karimi, Nicholas Taylor, Jainith Patel, Liana Wiepert, Ron I Riesenburger, James Kryzanski

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引用次数: 0

Abstract

Objective: Lumbar pedicle screw placement surgery involves various assistive technologies, including fluoroscopic, stereotactic, or robotic navigation and intraoperative neuromonitoring (IONM). We aimed to discern neurosurgeons' preferences for screw placement techniques and IONM utility, while also considering the influence of experience.

Methods: A survey was distributed to members of the Congress of Neurological Surgeons using REDCap software, collecting demographic data and querying preferred techniques for screw placement and IONM modalities. Opinions on IONM use during stereotactic or robotic navigation were also obtained. Responses were analyzed using Pearson's Chi-square and analysis of variance tests via R software.

Results: Of 188 responses, 35.5% (n = 67) reported 1-10 years of experience and 64.5% (n = 121) reported ≥ 11 years. Less experienced neurosurgeons used stereotactic navigation more than those with greater experience (P < 0.001). Seasoned neurosurgeons used fluoroscopic guidance more often (P = 0.038). Less experienced neurosurgeons employed 1.69 (± 0.11) techniques for their fixation surgeries compared to 1.50 (± 0.0.8) for more experienced neurosurgeons. Robotic navigation utilization was low and comparable between the groups. Surgeons employing multiple techniques used triggered electromyography the most (62.1%, P = 0.024). No strong opinions emerged on the necessity of multimodality IONM with robotic or stereotactic navigation.

Conclusions: This national survey shows that stereotactic navigation is the predominant technique for pedicle screw placement among less experienced neurosurgeons, with seasoned neurosurgeons leaning toward fluoroscopic guidance. Robotic guidance was the least used technique with no observed difference based on experience. Neurosurgeons employing multiple techniques use IONM the most, compared with surgeons who only use stereotactic navigation and/or robotic guidance.

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基于全国神经外科调查的腰椎椎弓根螺钉置入术中使用神经监测、图像引导和机器人技术的实践模式差异。

目的：腰椎椎弓根螺钉置入手术涉及多种辅助技术，包括透视、立体定向或机器人导航和术中神经监测（IONM）。我们旨在了解神经外科医生对螺钉置入技术和 IONM 实用性的偏好，同时考虑经验的影响：我们使用 REDCap 软件向神经外科医师大会的成员发放了一份调查问卷，收集了人口统计学数据，并询问了首选的螺钉置入技术和 IONM 模式。此外，还收集了关于在立体定向或机器人导航过程中使用 IONM 的意见。通过R软件使用Pearson's Chi Square和方差分析对回复进行分析：在188份回复中，35.5%（n=67）的回复者表示有1-10年的经验，64.5%（n=121）的回复者表示有≥11年的经验。经验较少的神经外科医生比经验丰富的神经外科医生更多使用立体定向导航（p < 0.001）。经验丰富的神经外科医生更常使用透视引导（p = 0.038）。经验较少的神经外科医生在固定手术中使用了1.69（±0.11）种技术，而经验丰富的神经外科医生则使用了1.50（±0.0.8）种技术。机器人导航的使用率较低，两组之间的使用率相当。采用多种技术的外科医生使用t-EMG的比例最高（62.1%，p = 0.024）。对于是否有必要使用机器人或立体定向导航进行多模式 IONM，没有出现强烈的意见：这项全国性调查显示，在经验较少的神经外科医生中，立体定向导航是椎弓根螺钉置入的主要技术，而经验丰富的神经外科医生则倾向于透视引导。机器人引导是使用最少的技术，而且没有观察到经验上的差异。与只使用立体定向导航和/或机器人引导的外科医生相比，使用多种技术的神经外科医生使用IONM最多。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.