Awake Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion Under Spinal Anesthesia: Screw Placement Accuracy and 1 Year Follow-Up.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
Gaetano De Biase, Benjamin F Gruenbaum, Elird Bojaxhi, Jennifer S Patterson, Katherine Sabetta, Alfredo Quinones-Hinojosa, Kingsley Abode-Iyamah
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引用次数: 0

Abstract

Objective: We assessed the accuracy of pedicle screws placed during awake minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) under spinal anesthesia and analyzed outcomes at the 1-year follow-up.

Methods: We included patients who underwent awake MIS-TLIF under spinal anesthesia at an academic center from February 2020 to February 2022. The Gertzbein-Robbins classification was used for screw accuracy rating.

Results: A total of 100 pedicle screws were inserted in 24 patients, with the most common level being L4-5. Median age was 63.5 ± 16.5 (interquartile range) years, 42% male, median body mass index 28 ± 6 kg/m2, and median American Society of Anesthesiologists class was 2 ± 1. Two patients underwent a 2-level fusion, and 22 patients underwent a 1-level fusion. Median estimated blood loss was 35 ± 25 mL, median length of stay was 0 ± 1 day, with 54% of patients going home on the day of surgery, and the only intraoperative complication was 1 durotomy. Median procedure time was 112 ± 23.5 minutes, and median operating room time (including the spinal block) was 159.5 ± 32.7 minutes; 67% of the screws were placed with navigation, and 33% were robotic-assisted (Mazor X); 99% of the screws were Gertzbein Robins grade A, and 1% grade E. At the 1 year follow-up, computed tomography showed no evidence of pseudarthrosis, and all patients reported improvement in their presenting symptoms.

Conclusions: Our study shows a high accuracy (99%) of pedicle screw placement in patients undergoing awake MIS-TLIF under spinal anesthesia and significant improvement of their symptoms at 1-year follow-up.

脊柱麻醉下的清醒 MIS-TLIF:螺钉植入的准确性和 1 年随访。
目的:我们评估了脊柱麻醉下清醒微创经椎间孔腰椎椎体融合术(MIS-TLIF)中椎弓根螺钉置入的准确性,并分析了一年随访的结果:我们纳入了2020年2月至2022年2月在一家学术中心接受脊髓麻醉下清醒MIS-TLIF的患者。采用Gertzbein-Robbins分类法对螺钉的准确性进行评级:24名患者共植入100枚椎弓根螺钉,最常见的水平是L4-5。中位年龄为63.5±16.5(IQR)岁,42%为男性,中位体重指数为28±6 kg/m2,中位美国麻醉学会等级为2±1。估计失血量中位数为(35±25)毫升,住院时间中位数为(0±1)天,54%的患者在手术当天即可回家,术中唯一的并发症是一次穹隆切开术。手术时间中位数为(112±23.5)分钟,手术室时间中位数(包括脊柱阻滞)为(159.5±32.7)分钟;67%的螺钉通过导航植入,33%通过机器人辅助植入(Mazor X);99%的螺钉为Gertzbein Robins A级,1%为E级:结论:我们的研究表明,在脊髓麻醉下进行清醒微创经椎间孔腰椎椎体融合术(MIS-TLIF)时,椎弓根螺钉置入的准确率很高(99%),随访一年后患者的症状明显改善。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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