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Title: [Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion].
Author: Lin X, Chang Q, Shang L, Shen S, Fu Z, Wang Y, Zhou L, Fu H, Zhao G.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Nov 15; 37(11):1403-1409. PubMed ID: 37987052.
Abstract:
OBJECTIVE: To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. METHODS: Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. RESULTS: The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697). CONCLUSION: UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations. 目的: 微创经椎间孔入路腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）中O臂导航与超声容积导航（ultrasound volume navigation，UVN）引导螺钉植入的疗效比较。. 方法: 将2022年6月—2023年6月收治且符合选择标准的因腰椎间盘突出行MIS-TLIF的60例患者纳入研究，随机分为A组（MIS-TLIF术中采用UVN引导螺钉植入）和B组（MIS-TLIF术中采用O臂导航技术引导螺钉植入），每组30例。两组患者性别、年龄、身体质量指数和手术节段等基线资料比较差异均无统计学意义（ P>0.05）。术中记录并计算平均单枚螺钉植钉时间、总辐射剂量和平均单枚螺钉有效辐射剂量，术后10 d行X线片及CT检查评价植钉准确性及小关节侵犯情况，并采用Pearson相关和Spearman秩相关分析平均单枚螺钉植钉时间及植钉准确性分级与BMI的关系。. 结果: B组平均单枚螺钉植钉时间短于A组，单节段及多节段患者总辐射剂量以及平均单枚螺钉辐射剂量明显多于A组，差异均有统计学意义（ P<0.05）；B组内单节段及多节段患者间总辐射剂量差异无统计学意义（ P>0.05），A组多节段患者总辐射剂量大于单节段患者，差异有统计学意义（ P<0.05）。两组植钉准确性分级比较差异无统计学意义（ P>0.05）；两组中1、2级螺钉均为向椎弓根外壁突破，无突破椎弓根内壁的螺钉。两组小关节侵犯率比较差异亦无统计学意义（ P>0.05）。A组平均单枚螺钉植钉时间和植钉准确性分级均与BMI成正相关（ r=0.677， P<0.001； r=0.222， P=0.012），而B组二者与BMI均无相关性（ r=0.224， P=0.233； r=0.034， P=0.697）。. 结论: MIS-TLIF术中UVN引导螺钉植入具有媲美O臂导航的省时性、直观性、准确性，以及超越O臂导航的低辐射性，但也会受肥胖等因素影响，存在一定局限性。.

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