SHORT-TERM EFFECTIVENESS OF SPINAL NAVIGATION WITH INTRA-OPERATIVE THREE-DIMENSIONAL-IMAGING MODALITY IN PEDICLE SCREW FIXATION FOR CONGENITAL SCOLIOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Lin , SONG Yueming , GONG Quan , LIU Limin , ZHOU Chunguang , ZHOU Zhongjie.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: GONG Quan, E-mail: gong_quan@sohu.com;

Corresponding author：

Keywords：

Intra-operative three-dimensional-imaging modality; Computer assistance; Congenital scoliosis; Pedicle screw

DOI：

10.7507/1002-1892.20130030

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Objective To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS). Methods Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P gt; 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter’s standard and the correction of Cobb angle was assessed by X-ray films. Results All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P gt; 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (χ2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter’s standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= — 1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P lt; 0.05), but there was no significant difference between 1 week and last follow-up (P gt; 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957). Conclusion Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.

Citation： SUN Lin,SONG Yueming,GONG Quan,LIU Limin,ZHOU Chunguang,ZHOU Zhongjie.. SHORT-TERM EFFECTIVENESS OF SPINAL NAVIGATION WITH INTRA-OPERATIVE THREE-DIMENSIONAL-IMAGING MODALITY IN PEDICLE SCREW FIXATION FOR CONGENITAL SCOLIOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 129-134. doi: 10.7507/1002-1892.20130030 Copy

1.	20 邢丹, 马信龙, 宋东辉, 等. 导航下脊柱椎弓根钉置入与传统置入术临床疗效的Meta分析. 中国骨伤, 2012, 25(10): 825-830.
2.	Holly LT, Foley KT. Intraoperative spinal navigation. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S54-61.
3.	Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J, 2004, 13(1): 50-59.
4.	齐万里. 20例先天性脊柱侧弯手术时机的分析. 中国医学工程, 2011, 19(11): 63, 65.
5.	Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17): 1791-1799.
6.	郝定均, 贺宝荣, 王晓东, 等. 后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形. 中国脊柱脊髓杂志, 2009, 19(3): 188-192.
7.	Dubousset J, ZellerR, Miladi L, et al. Orthopedic treatment of spinal deformities in infancy and early childhood. Rev Chir Orthop Reparatrice Appear Mot, 2006, 92(1): 73-82.
8.	余可谊, 邱贵兴, 王以朋. 先天性脊柱侧凸手术治疗策略——进展与挑战. 中国骨与关节外科, 2008, 1(2): 158-163.
9.	Ruf M, Jensen R, Jeszenszky D, et al. Hemivertebra resection in congenital scoliosis-early correction in young children. Z Orthop Ihre Grenzgeb, 2006, 144(1): 74-79.
10.	Ranade A, Samdani AF, Williams R, et al. Feasibility and accuracy of pedicle screws in children younger than eight years of age. Spine (Phila Pa 1976), 2009, 34(26): 2907-2911.
11.	Suk SI, KimWJ, Lee SM, et al. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
12.	惠华, 罗卓荆, 陶惠人, 等. 快速成型技术在复杂脊柱畸形矫治手术中的应用. 脊柱外科杂志, 2008, 6(5): 274-276.
13.	桑宏勋, 雷伟, 马真胜, 等. 快速成型技术在重度先天性脊柱畸形矫形手术中的应用. 中国脊柱脊髓杂志, 2008, 18(3): 196-200.
14.	Amoit LP, Labelle H, DeGuise JA, et al. Computer-assisted pedicle screw fixation. A feasibility study. Spine (Phila Pa 1976), 1995, 20(10): 1208-1212.
15.	俞兴, 徐林. 三种脊柱影像导航技术特点分析. 中国组织工程研究与临床康复, 2007, 11(Suppl): 58-59.
16.	闫士举, 钱理为, 葛斌. 基于C型臂脊柱手术导航技术研究与系统实现. 生物医学工程学杂志, 2011, 28(2): 280-283.
17.	Rajasekaran S, Kanna PR, Shetty AP. Safety of cervical pedicle screw insertion in children: a clinicoradiological evaluation of computer-assisted insertion of 51 cervical pedicle screws including 28 subaxial pedicle screws in 16 children. Spine (Phila Pa 1976), 2012, 37(4): E216-223.
18.	Ughwanogho E, Patel NM, Baldwin KD, et al. Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976), 2012, 37(8): E473-478.
19.	Costa F, Cardia A, Ortolina A, et al. Spinal navigation: standard preoperative versus intraoperative computed tomography data set acquisition for computer-guidance system: radiological and clinical study in 100 consecutive patients. Spine (Phila Pa 1976), 2011, 36(24): 2094-2098.
20.	杨曦, 孔清泉, 宋跃明, 等. 计算机导航辅助椎弓根螺钉后路固定在骨质疏松患者中的临床应用. 中国修复重建外科杂志, 2012, 26(2): 196-200.

1. 20 邢丹, 马信龙, 宋东辉, 等. 导航下脊柱椎弓根钉置入与传统置入术临床疗效的Meta分析. 中国骨伤, 2012, 25(10): 825-830.
2. Holly LT, Foley KT. Intraoperative spinal navigation. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S54-61.
3. Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J, 2004, 13(1): 50-59.
4. 齐万里. 20例先天性脊柱侧弯手术时机的分析. 中国医学工程, 2011, 19(11): 63, 65.
5. Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17): 1791-1799.
6. 郝定均, 贺宝荣, 王晓东, 等. 后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形. 中国脊柱脊髓杂志, 2009, 19(3): 188-192.
7. Dubousset J, ZellerR, Miladi L, et al. Orthopedic treatment of spinal deformities in infancy and early childhood. Rev Chir Orthop Reparatrice Appear Mot, 2006, 92(1): 73-82.
8. 余可谊, 邱贵兴, 王以朋. 先天性脊柱侧凸手术治疗策略——进展与挑战. 中国骨与关节外科, 2008, 1(2): 158-163.
9. Ruf M, Jensen R, Jeszenszky D, et al. Hemivertebra resection in congenital scoliosis-early correction in young children. Z Orthop Ihre Grenzgeb, 2006, 144(1): 74-79.
10. Ranade A, Samdani AF, Williams R, et al. Feasibility and accuracy of pedicle screws in children younger than eight years of age. Spine (Phila Pa 1976), 2009, 34(26): 2907-2911.
11. Suk SI, KimWJ, Lee SM, et al. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
12. 惠华, 罗卓荆, 陶惠人, 等. 快速成型技术在复杂脊柱畸形矫治手术中的应用. 脊柱外科杂志, 2008, 6(5): 274-276.
13. 桑宏勋, 雷伟, 马真胜, 等. 快速成型技术在重度先天性脊柱畸形矫形手术中的应用. 中国脊柱脊髓杂志, 2008, 18(3): 196-200.
14. Amoit LP, Labelle H, DeGuise JA, et al. Computer-assisted pedicle screw fixation. A feasibility study. Spine (Phila Pa 1976), 1995, 20(10): 1208-1212.
15. 俞兴, 徐林. 三种脊柱影像导航技术特点分析. 中国组织工程研究与临床康复, 2007, 11(Suppl): 58-59.
16. 闫士举, 钱理为, 葛斌. 基于C型臂脊柱手术导航技术研究与系统实现. 生物医学工程学杂志, 2011, 28(2): 280-283.
17. Rajasekaran S, Kanna PR, Shetty AP. Safety of cervical pedicle screw insertion in children: a clinicoradiological evaluation of computer-assisted insertion of 51 cervical pedicle screws including 28 subaxial pedicle screws in 16 children. Spine (Phila Pa 1976), 2012, 37(4): E216-223.
18. Ughwanogho E, Patel NM, Baldwin KD, et al. Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976), 2012, 37(8): E473-478.
19. Costa F, Cardia A, Ortolina A, et al. Spinal navigation: standard preoperative versus intraoperative computed tomography data set acquisition for computer-guidance system: radiological and clinical study in 100 consecutive patients. Spine (Phila Pa 1976), 2011, 36(24): 2094-2098.
20. 杨曦, 孔清泉, 宋跃明, 等. 计算机导航辅助椎弓根螺钉后路固定在骨质疏松患者中的临床应用. 中国修复重建外科杂志, 2012, 26(2): 196-200.

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Chinese Journal of Reparative and Reconstructive Surgery

SHORT-TERM EFFECTIVENESS OF SPINAL NAVIGATION WITH INTRA-OPERATIVE THREE-DIMENSIONAL-IMAGING MODALITY IN PEDICLE SCREW FIXATION FOR CONGENITAL SCOLIOSIS

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