P37。术中图像引导脊柱导航技术对腰椎内镜手术的影响：一项系统综述和荟萃分析

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100661

Hsu I Chou MD , Yu Che Wang MD , Meng Huang Wu MD, PhD

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引用次数: 0

摘要

背景：腹腔镜腰椎手术（ELSS）是一种主流手术，可以最大限度地减少软组织损伤，促进更快的恢复，并提高手术的可视性。然而，采用它需要一个陡峭的学习曲线，特别是传统的透视引导，因为它需要精确定位脊柱病理和导航内窥镜解剖。术中图像引导脊柱导航提供术中实时成像，可以增强病理定位，优化工作通道放置，促进ELSS的学习过程。目的：本研究探讨术中图像引导脊柱导航是否对ELSS有围术期和临床优势。研究设计/设置：系统评价和荟萃分析。患者样本：本分析包括来自19项研究的1390名患者，比较术中图像引导脊柱导航和常规c臂透视在ELSS中的结果。主要结果包括围手术期指标，如手术时间、穿刺次数、插管时间、透视使用频率和辐射剂量。临床结果包括住院时间、视觉模拟评分（VAS）评分和Oswestry残疾指数（ODI）评分。方法我们系统地检索PubMed、Europe PMC、Scopus、Cochrane Library和ClinicalTrials.gov，以比较术中图像引导导航与常规c臂透视在ELSS中的效果。结果共纳入19项研究，1390例患者。术中图像引导脊柱导航与较短的总手术时间显著相关(平均差[MD] = -11.18 min， 95%可信区间[CI] = -14.67 ~ -7.70,P <；. 01;I2 = 83%),减少穿刺尝试(MD = -2.94,95% CI = -5.02到-0.87,P & lt;0.01, I2 = 99%)，插管时间较短(MD = -12.59 min, 95% CI = -19.45 ~ -5.74,P <；0.01, I2 = 97%)，较低的透视使用频率(MD = -14.75次，95% CI = -24.36 ~ -5.13,P <；0.01, I2 = 100%)，较低的辐射暴露(标准化MD = -4.18,95% CI = -5.58至-2.78,P <；. 01, I2 = 93%),和更短的住院时间(MD = -0.44天,95% CI = -0.84到-0.03,P = 。03, I2 = 83%)与c臂透视相比较。在长达1年的随访中，背部VAS评分、腿部VAS评分或ODI评分均无显著差异。结论术中图像引导脊柱导航在ELSS手术中可显著减少患者和手术人员的总手术时间和辐射暴露。此外，它可以通过减少穿刺次数和插管时间来促进ELSS的学习过程。尽管有这些术中益处，但其临床结果仍与传统c臂透视相当。需要进一步的研究来评估术中导航在不同医疗保健系统中的成本效益，以进一步验证其更广泛的适用性。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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P37. Effect of intraoperative image-guided spinal navigation technologies on endoscopic lumbar spine surgery: a systematic review and meta-analysis

BACKGROUND CONTEXT

Endoscopic lumbar spine surgery (ELSS) is a mainstream procedure that minimizes soft tissue damage, promotes faster recovery, and enhances surgical visualization. However, its adoption involves a steep learning curve, particularly with conventional fluoroscopic guidance, because it requires precise targeting of spinal pathology and navigating endoscopic anatomy. Intraoperative image-guided spinal navigation provides real-time imaging during surgery and can enhance pathology localization, optimize working channel placement, and facilitate the learning process of ELSS.

PURPOSE

This study examined whether intraoperative image-guided spinal navigation offers perioperative and clinical advantages in ELSS.

STUDY DESIGN/SETTING

A systematic review and meta-analysis.

PATIENT SAMPLE

This analysis included 1390 individuals from 19 studies comparing the outcomes of intraoperative image-guided spinal navigation and conventional C-arm fluoroscopy in ELSS.

OUTCOME MEASURES

The primary outcomes included perioperative metrics such as operation time, number of puncture attempts, cannulation time, fluoroscopy use frequency, and radiation dose. Clinical outcomes included length of stay, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores.

METHODS

We systematically searched PubMed, Europe PMC, Scopus, Cochrane Library, and ClinicalTrials.gov for studies comparing the outcomes of intraoperative image-guided navigation with conventional C-arm fluoroscopy in ELSS.

RESULTS

A total of 19 studies involving 1,390 patients were included for meta-analysis. Intraoperative image-guided spinal navigation in ELSS was significantly associated with a shorter total operation time (mean difference [MD] = -11.18 min, 95% confidence interval [CI] = -14.67 to -7.70, P < .01; I2 = 83%), fewer puncture attempts (MD = -2.94, 95% CI = -5.02 to -0.87, P < .01, I2 = 99%), shorter cannulation time (MD = -12.59 min, 95% CI = -19.45 to -5.74, P < .01, I2 = 97%), lower fluoroscopy use frequency (MD = -14.75 times, 95% CI = -24.36 to -5.13, P < .01, I2 = 100%), lower radiation exposure (standardized MD = -4.18, 95% CI = -5.58 to -2.78, P < .01, I2 = 93%), and shorter hospital stay (MD = -0.44 days, 95% CI = -0.84 to -0.03, P = .03, I2 = 83%) compared with C-arm fluoroscopy. No significant differences in back VAS scores, leg VAS scores, or ODI scores were observed at up to 1 year of follow-up.

CONCLUSIONS

Intraoperative image-guided spinal navigation in ELSS significantly reduces the total operation time and radiation exposure for both patients and surgical staff. Additionally, it may facilitate the learning process of ELSS by reducing the number of puncture attempts and the duration of cannulation. Despite these intraoperative benefits, its clinical outcomes remain comparable to those of conventional C-arm fluoroscopy. Further research is required to evaluate the cost-effectiveness of intraoperative navigation across diverse health-care systems to further validate its broader applicability.