OMURGA CERRAHİSİNDE SERBEST EL TEKNİĞİ VE ÜÇ BOYUTLU BİLGİSAYARLI TOMOGRAFİ DESTEKLİ NAVİGASYON SİSTEMİYLE YERLEŞTİRİLEN PEDİKÜL VİDALARININ YÖNELİM DOĞRULUĞUNUN KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA

Abstract

Amaç: Spinal cerrahide kullanılan pedikül vida yerleştirme tekniklerinden serbest el tekniği ve üç boyutlu bilgisayarlı tomografi (3D-BT) destekli navigasyon tekniği, vida yerleştirme ve güvenilirlik açısından karşılaştırıldı. Gereç ve Yöntem: Pedikül vidası ile spinal enstrümantasyon uygulanan 73 spinal deformiteli hastanın toplam 1664 vidası çalışmada değerlendirildi. Serbest el tekniği grubunda 40 hasta ve 3D-BT destekli navigasyon tekniği grubunda 33 hasta vardı. Pedikül vidalarının tüm hastalarda yerleştirilmesi ve güvenilirliği, ameliyat sonrası dönemde çekilen BT görüntüleri kullanılarak Gertzbein-Robbins sınıflaması kullanılarak değerlendirildi. Bulgular: Yaş, vücut kitle indeksi (VKİ), cinsiyet (kadın veya erkek) ve deformite (skolyoz veya kifoz) açısından gruplar arası anlamlı fark bulunmadı (p>0,05). Pedikül vidaları transvers penetrasyon açısından değerlendirildiğinde, 3D-BT destekli navigasyon tekniğinde Grade A (%89,6), serbest el tekniğinde Grade A (%76,5) olarak belirlendi. 3D-BT destekli navigasyon tekniği trasvers penetrasyon açısından istatistiksel olarak daha güvenilir tespit edildi (p<0,001). Pedikül vidaları anterior penetrasyon açısından değerlendirildiğinde, hem 3D-BT yardımlı navigasyon tekniğinde Grade A (%92,5) ve serbest el tekniğine Grade A (%82,9) olarak belirlendi. 3D-BT yardımlı navigasyon tekniği anterior penetrasyon açısından istatistiksel olarak daha güvenilir tespit edildi (p<0,001). Sonuç: Çalışmamızın sonuçlarına göre, omurga deformitelerini içeren ameliyatlarda pedikül vidası yerleştirmede 3D-BT destekli navigasyon tekniği serbest el tekniği ile karşılaştırıldığında daha güvenilirdir.

Keywords

• omurga deformitesi
• navigasyon
• posterior enstrümantasyon

COMPARING THE TRAJECTORY ACCURACY OF PEDICLE SCREWS PLACED WITH A FREE-HAND TECHNIQUE AND A THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-ASSISTED NAVIGATION SYSTEM IN SPINE SURGERY: A RETROSPECTIVE STUDY

Abstract

Objective: We evaluated a free-hand technique and a three-dimensional computerized tomography (3D-CT)-assisted navigation technique, which are pedicle screw placement techniques used in spinal surgery, regarding screw placement and reliability. Materials and Methods: A total of 1664 screws in 73 patients with spinal deformities who underwent spinal instrumentation using pedicle screws were evaluated in this study. Forty patients were in the free-hand technique group, and 33 patients were in the 3D-CT-assisted navigation technique group. The placement and reliability of pedicle screws in all patients were evaluated using the Gertzbein–Robbins classification using CT images taken in the postoperative period. Result: There were no significant differences found regarding age, body mass index (BMI), sex (female or male), or deformity (scoliosis or kyphosis) (p>0.05). When the pedicle screws were evaluated in terms of transverse penetration, the 3D-CT-assisted navigation technique was determined Grade A (89.6%), as was the free-hand technique (76.5%), but the 3D-CT-assisted navigation technique was statistically more reliable (p<0.001). When the pedicle screws were evaluated in terms of anterior penetration, both the 3D-CT-assisted navigation technique (92.5%) and the free-hand technique (82.9%) were determined Grade A, but the 3D-CT-assisted navigation technique was statistically more reliable (p<0.001). Conclusion: According to our study’s results, the 3D-CT-assisted navigation technique is more reliable than the free-hand technique in surgeries involving spine deformities for pedicle screw insertion.

Keywords

• spine deformity
• navigation
• posterior instrumentation

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