P18。影响颈椎前路椎间盘切除术和融合术中颈椎侧位透视最低可见水平的因素

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100642

Siddharth A. Badve MD

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引用次数: 0

摘要

背景背景在颈前路椎间盘切除术和融合术（ACDF）中，在术中获得足够的颈椎可视化是具有挑战性的。很少有关于患者和外科医生因素的信息可以有效地预测术中颈椎水平的可视化程度。我们假设颈椎显像程度受到特定患者变量、术前侧位直立x线片参数和术中患者定位技术的影响。目的本研究的目的是确定影响ACDF患者术中最低可见椎体x线片的患者变量和外科医生位置变量。研究设计/设置：对一家区域性多中心医院的回顾性图表进行回顾。患者样本：接受ACDFOUTCOME测量的成年患者，术中观察的预测人口学因素的验证，以及基于术中椎体水平与术前基线直立颈椎x线片的差异计算的新型颈椎观察评分。方法本回顾性研究检查了在一个大的、综合的系统中接受ACDF的成年患者。根据直立x线片测量的一系列颈椎放射参数，获得患者人口统计学因素，以确定术中可视化的预测因素。根据术中椎体水平与术前基线水平的差异计算一种新的颈椎可视化评分。采用多元反向线性回归分析患者人口统计学和放射学参数。采用双样本t检验确定牵引技术与非牵引技术在术前和术中视觉效果的差异。采用单因素方差分析和事后分析分别确定牵引组和非牵引组可视化评分的差异。两名独立研究人员对所有放射测量结果进行了评估。结果共纳入151例电子识别患者。BMI升高和牵引的使用显著降低了可视化评分。高T1坡度适度改善了视觉效果。牵引组在最低可见椎体（C7下半部和C7- t1椎间盘）的可视化评分与术前同等可视化的非牵引组相比显著降低。牵引稳定患者的两两比较显示，术前C7-T1椎间盘水平的显像明显低于C6上半截。非牵引组的方差分析无统计学意义。平均ICC值为0.90，显示了良好的率间信度（ICC范围为0.75 ~ 0.97）。结论BMI、牵引、T1坡度等因素影响ACDF患者最低可见颈椎。未使用牵引的患者术前所有椎体水平的可视化评分相似。此外，术中牵引的使用似乎降低了视觉评分，特别是在C7-T1水平。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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P18. Factors influencing the lowest visible level on lateral cervical fluoroscopy during anterior cervical discectomy and fusion

BACKGROUND CONTEXT

Obtaining adequate intraoperative visualization of cervical vertebra can prove challenging during anterior cervical discectomy and fusion (ACDF). There is little information about patient and surgeon factors that can effectively predict the degree of intraoperative visualization of cervical vertebral level. We hypothesize that the degree of cervical visualization is impacted by specific patient variables, preoperative lateral upright radiographic parameters, and intraoperative patient positioning technique.

PURPOSE

The purpose of this study is to identify patient variables and surgeon positioning variables that influence lowest visible vertebra on intraoperative radiographs for patients undergoing ACDF.

STUDY DESIGN/SETTING

Retrospective chart review at a regional multicenter hospital.

PATIENT SAMPLE

Adult patients who underwent ACDF

OUTCOME MEASURES

Identification of predictive demographic factors for intraoperative visualization, as well as a novel cervical visualization score calculated based on intraoperative vertebral level difference from preoperative baseline upright cervical radiographs.

METHODS

This retrospective study examined adult patients who underwent ACDF in a large, integrated system. Patient demographic factors were obtained to identify predictors of intraoperative visualization based on a series of radiographic cervical parameters measured on upright radiographs. A novel cervical visualization score was calculated based on intraoperative vertebral level difference from preoperative baseline level. Patient demographic and radiographic parameters were analyzed using a multivariate backward linear regression. Differences in pre-and-intraoperative visualization among traction versus non-traction techniques were determined with a two-sample t-test. One-way ANOVA and post hoc analyses were used to identify differences in visualization scores in traction and non-traction groups separately. Inter-rater reliability was assessed for all radiographic measurements made by two independent researchers.

RESULTS

There were 151 electronically identified patients included. Elevated BMI and use of traction significantly reduced visualization scores. High T1 slope modestly improved visualization. Traction group visualization scores at lowest visualized vertebra (C7 lower half and C7-T1 disc) showed a significant decrease compared to non-traction group with equal preoperative visualization. Pairwise comparisons for traction stabilized patients showed a significantly reduced visualization at the preoperative C7-T1 disc level compared to C6 upper half. ANOVA analysis within the non-traction group showed no statistical significance. The averaged ICC of 0.90 demonstrates excellent inter-rate reliability (ICC range of 0.75-0.97)

CONCLUSIONS

These data indicate that specific factors such as BMI, use of traction and T1 slope impact the lowest visible cervical vertebra for patients undergoing ACDF. Patients without use of traction have similar visualization scores across all preoperative vertebral levels. In addition, use of intraoperative traction appears to reduce visualization scores especially at the C7-T1 level.