Clinical Efficiency and Radiation Safety of Fluoroscopy-Based 2D Intraoperative Computer Navigation in Biportal Spinal Endoscopy.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-09-02 DOI:10.14444/8780

Don Young Park, Haley Nadone, Andy Ton, Ryan Hoang, Arthur Cowman, Michael Kim, Hao-Hua Wu, Hansen Bow, Sohaib Hashmi, Yu-Po Lee, Michael Oh, Cheol Wung Park, Heo Dong Hwa, Nitin Bhatia

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引用次数: 0

Abstract

Background: Endoscopic spine surgery is a minimally invasive technique that can treat spinal conditions while resulting in less pain and faster recovery than alternative techniques. However, achieving precise navigation is challenging without significant radiation exposure and increased surgical times. Fluoroscopy-based 2-dimensional navigation (2DNAV) is an emerging technology that offers real-time navigation using intraoperative fluoroscopy. This study evaluated the clinical efficiency and radiation safety of 2DNAV in biportal endoscopic spine surgery as compared with conventional C-arm fluoroscopy.

Methods: This prospective comparative cohort study included 20 biportal endoscopic patients using 2DNAV and 20 case-matched control patients using C-arm fluoroscopy. Primary outcomes included operative time, number of fluoroscopic images, radiation exposure time, and total radiation dose. Additionally, a visual analog scale for back and leg pain and the Oswestry Disability Index were obtained.

Results: Mean operative time in the 2DNAV group (67.95 ± 14.4 minutes) was significantly shorter compared with the control group (83.0 ± 16.0 minutes, P = 0.003). The mean number of fluoroscopic images required was significantly less in the 2DNAV group (3.15 ± 1.6 images) with vs control group (17.95 ± 5.7 images, P < 0.001). Total radiation exposure time was significantly lower in the 2DNAV group (mean 1.9 ± 1.1 min:sec) vs the control group (mean 9.21 ± 5.6 min:sec, P < 0.001). 2DNAV group experienced mean radiation dose of 0.77 ± 0.4 mGy vs 6.21 ± 3.8 mGy in control (P < 0.001). There were no significant differences in clinical outcomes.

Conclusions: 2DNAV significantly reduced operative times and required significantly fewer fluoroscopic images with lower radiation exposure for patients. 2DNAV allowed for the successful completion of the procedures with no difference in clinical outcomes.

Clinical relevance: 2DNAV provides real-time instrument tracking and computer navigation during endoscopic spine surgery with significantly decreased operative time and radiation exposure with similar clinical outcomes as conventional fluoroscopy.

Level of evidence: 2:

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基于x线透视的二维术中计算机导航在双门静脉脊柱内窥镜检查中的临床疗效和辐射安全性。

背景：内窥镜脊柱手术是一种微创技术，可以治疗脊柱疾病，同时比其他技术产生更少的疼痛和更快的恢复。然而，在没有明显辐射暴露和增加手术时间的情况下实现精确导航是具有挑战性的。基于透视的二维导航（2DNAV）是一项新兴技术，可通过术中透视提供实时导航。本研究评估了2DNAV在双门静脉内镜脊柱手术中的临床疗效和放射安全性，并与常规c臂透视进行了比较。方法：本前瞻性比较队列研究包括20例使用2DNAV的双门静脉内镜患者和20例使用c臂透视的病例匹配对照患者。主要结果包括手术时间、透视图像数量、辐射暴露时间和总辐射剂量。此外，还获得了背部和腿部疼痛的视觉模拟量表和Oswestry残疾指数。结果：2DNAV组平均手术时间（67.95±14.4分钟）明显短于对照组（83.0±16.0分钟，P = 0.003）。2DNAV组所需的平均透视图像数（3.15±1.6张）明显少于对照组（17.95±5.7张，P < 0.001）。2DNAV组总辐射暴露时间（平均1.9±1.1 min:sec）明显低于对照组（平均9.21±5.6 min:sec, P < 0.001）。2DNAV组平均辐射剂量为0.77±0.4 mGy，对照组为6.21±3.8 mGy （P < 0.001）。两组临床结果无显著差异。结论：2DNAV可显著减少患者手术次数，所需透视片数量明显减少，辐射暴露量较低。2DNAV允许手术成功完成，临床结果没有差异。临床意义：2DNAV在内镜脊柱手术中提供实时仪器跟踪和计算机导航，显著减少手术时间和辐射暴露，临床结果与常规透视相似。证据等级:2;

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.