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Genauigkeit der CT-basierten Navigation von Pedikelschrauben an der Brustwirbelsäule im Vergleich zur konventionellen Technik

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Zusammenfassung

Ziel dieser Arbeit war es, die Genauigkeit der CT-basierten Navigation von Pedikelschrauben an der Brustwirbelsäule (BWS) mithilfe eines optoelektronischen Navigationssystems bei Patienten mit Frakturen, Tumoren und Entzündungen im Vergleich zur konventionellen Technik zu untersuchen. Dazu wurden bei 85 Patienten 324 Pedikelschrauben, 211 navigiert und 113 konventionell, an der BWS gesetzt. Die Navigation erfolgte mit einem optoelektronischen System, wobei zusätzlich ein Bildverstärker zur Lagekontrolle verwendet wurde. Postoperativ wurde die Pedikelschraubenplatzierung mithilfe von Computertomogrammen (CT) dargestellt und durch einen unabhängigen Radiologen ausgewertet. In der navigierten Gruppe wurden 174 (82,5%) Schrauben korrekt platziert. In der konventionellen Gruppe waren es mit 77 (68,1%) Schrauben signifikant weniger (p<0,003). Allerdings ließen sich erhebliche Fehllagen von >4 mm in 1,9% der Fälle trotz Navigation nicht vermeiden. Die zusätzliche Röntgendurchleuchtung vermied v. a. die Navigation falscher Wirbelkörper sowie Abweichungen der Schrauben nach kaudal bzw. kranial.

Abstract

The goal of this study was to evaluate the accuracy of CT-based computer-assisted pedicle screw insertion in the thoracic spine in patients with fractures, metastases, and spondylodiscitis compared to a conventional technique. A total of 324 pedicle screws were inserted in the thoracic spines of 85 patients: 211 screws were placed using a CT-based optoelectronic navigation system assisted by an image intensifier and 113 screws were placed with a conventional technique. Screw positions were evaluated with postoperative CT scans by an independent radiologist. In the computer-assisted group, 174 (82.5%) screws were found completely within their pedicles compared with 77 (68.1%) correctly placed screws in the conventional group (p<0.003). Despite use of the navigation system, 1.9% of the computer-assisted screws perforated the pedicle wall by more than 4 mm. The additional use of the image intensifier helped to identify the correct vertebral body and avoided cranial or caudal pedicle wall perforations.

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Authors and Affiliations

  1. Zentrum für Muskuloskeletale Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Berlin

    K. J. Schnake, B. König, U. Berth, F. Kandziora, U. Stöckle, M. Raschke & N. P. Haas

  2. Klinik und Poliklinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Berlin

    R. J. Schroeder

  3. Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin

    K. J. Schnake

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  1. K. J. Schnake
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  2. B. König
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Schnake, K.J., König, B., Berth, U. et al. Genauigkeit der CT-basierten Navigation von Pedikelschrauben an der Brustwirbelsäule im Vergleich zur konventionellen Technik. Unfallchirurg 107, 104–112 (2004). https://doi.org/10.1007/s00113-003-0720-8

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