−IGS参考阵列位置对椎弓根螺钉置入精度和安全性的影响

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-09-01 DOI:10.1016/j.inat.2025.102122

Leonard Sang Xian Leong , Chin Hwee Goh , Eu Gene Teo , Abdul Rahman Izaini Ghani , Zamzuri Idris , Jafri Malin Abdullah , Albert Sii Hieng Wong

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引用次数: 0

摘要

目的椎弓根螺钉固定是稳定脊柱和提供三柱支撑的常用方法。图像引导手术（IGS）的出现彻底改变了脊柱外科手术，使外科医生能够以更高的准确性和安全性执行手术。IGS系统的关键组成部分之一是使用参考阵列（RA）和基于图像的导航来引导螺钉放置。本研究的目的是探讨椎弓根螺钉放置精度与距IGS参考阵列的距离之间的关系。方法2017年10月至2022年7月，对XX医院21例患者共植入93枚椎弓根螺钉（18枚颈椎螺钉，49枚胸椎螺钉，26枚腰椎螺钉）。通过术后CT扫描评估螺钉放置的准确性。结果采用Gertzbein-Robbins （GR）分级法对螺钉进行评分，分为0 - 3级（0级：螺钉在椎弓根内，1级：螺钉断裂≤2mm， 2级：螺钉断裂≤2mm， 3级：螺钉断裂≤4mm）。椎弓根螺钉放置进一步分为“满意放置”（0-1级）和“不满意放置”（2-3级）。80.6%的螺钉置入精度满意（≤2mm）。当使用IGS制导时，从RA到四个节段的距离对螺钉精度没有显著影响。只有1例患者出现并发症，可能是由于椎弓根螺钉固定时硬脑膜撕裂导致脑脊液泄漏。结论在研究范围内（最多为4节段），与参考阵列的距离对螺钉精度无显著影响。因此，对于参考阵列四个节段内的后路脊柱内固定，可能不需要重新扫描和重新定位，可能会减少手术时间。

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Accuracy and safety of pedicle screws inserted with IGS guidance − The impact of IGS reference array position

Objective

Pedicle screw fixation was a commonly used method for stabilizing the spine and providing 3-column support. The emergence of image-guided surgery (IGS) has revolutionized spinal surgery, allowing surgeons to perform procedures with greater accuracy and safety. One of the key components of IGS systems is the use of reference arrays (RA) and image-based navigation to guide screw placement. The aim of this study was to investigate the relationship between pedicle screw placement accuracy and the distance from the IGS reference array.

Method

A total of 93 pedicle screws (18 cervical, 49 thoracic, and 26 lumbar) were inserted in 21 patients at Hospital XX between October 2017 and July 2022. The accuracy of screw placement was evaluated using post-operative CT scans.

Results

The screws were rated on the Gertzbein-Robbins (GR) classification scale, which assigned Grades 0–3 (Grade 0: Screw within pedicle, Grade 1: ≤2 mm breach, Grade 2: >2 – 4 mm breach, Grade 3: >4 mm breach). The pedicle screw placement was further divided into “Satisfactory Placement” (Grade 0–1) and “Unsatisfactory Placement” (Grade 2–3). The accuracy of screw placement was satisfactory (≤2 mm) in 80.6 % of all segments. The distance from the RA up to four segments did not significantly affect screw accuracy when using IGS guidance. Only one patient experienced a complication, which was a CSF leak likely due to a dural tear during pedicle screw fixation.

Conclusion

The results suggested that the distance from the reference array did not significantly affect screw accuracy within the studied range (up to four segments). Therefore, for posterior spinal instrumentation within four segments from the reference array, re-scanning and re-registration may not be necessary, potentially reducing operative time.

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