| Purpose: To investigate the surgery of lumbar degenerative disease using two-dimensional computer assisted navigation technique and X-ray fluoroscopy assisted pedicle screw placement accuracy and safety.Method: Retrospective analysis in January 2014 to September 2015 period,the affiliated yijishan Hospital of Wannan Medical College admitted patients with degenerative disorders of the lumbar spine,posterior lumbar spinal incision decompression and single lumbar intervertebral fusion and pedicle screw fixation(single gap PLIF)and operation were used two-dimensional computer aided navigation or fluoroscopy assisted pedicle screw placement.Inclusion criteria: Patients with lumbar degenerative disease after standard conservative treatment,and no improvement in symptoms after;surgery require neurological signs and patients informed;assured preoperative lumbar normal lateral and dynamic radiography and CT/MRI examination,complete information;to ensure the accuracy of the evaluation,the operation section of this study the choice was L4/5 or L5/S1;the intraoperative fluoroscopy in computer assisted navigation or completion of pedicle screw placement assisted surgery;with complete and accurate screw placement records,operation time,bleeding volume,postoperative fluoroscopy times;postoperative lumbar vertebral fixation radiography and CT examination in 3-7 days;Surgery of the navigation group and traditional clinical surgery group were conducted by one experienced doctor.37 patients were included in this study,7 lumbar disc herniation,20 degenerative lumbar spinal stenosis,10 cases of degenerative lumbar spondylolisthesis;including 17 males,20 females,age between 45-72 years old,mean age 54.7 years;with L4 or L5 / S1 intervertebral fusion and pedicle screw fixation(4 pedicle screws was implanted).In total of 148 implanted screws,included 56 pieces of L4,74 pieces in L5 vertebral,18 screws in S1 vertebral.This study is carried out in 19 patients though a computer navigation assisted pedicle screw strategy(navigation group),9 males and 10 females,the average age of 56.4 years,4 cases of lumbar disc herniation,10 cases of degenerative lumbar spinal stenosis,5 cases of degenerative lumbar spondylolisthesis,a total placement of 76 pedicle screws,which the L4 body 28 pieces,38 pieces of L5 vertebral body,vertebral body of S1 10;the traditional pedicle screw group(fluoroscopy group)included 18 patients,8 males and 10 females,the average age of 55.8 years,3 cases of lumbar disc herniation,10 cases of degenerative lumbar spinal stenosis,5 cases of degenerative lumbar spine spondylolisthesis,72 pedicle screws were implanted,including L4 vertebrae 28,L5 body 36 pieces,8 pieces of S1 vertebral body.Comparisons between two groups in pedicle screw placement time,operative time,X-ray radiation exposure times,intraoperative bleeding volume,nailing excellent rate(according to Richter classification of assessment),disposable pedicle screw success rate and bilateral pedicle screw placement were conducted.Results: All pedicle screw were placed in patients without injury symptoms from nailing to cauda equina,no cerebrospinal fluid leakage.The navigation group of 76 pedicle screws,average single screw placement time was(6.4 ± 1.2)min operation,the average amount of bleeding(353.2 ± 15.8)ml operation,average operation time(143.5 ± 7.2)min,each operation average fluoroscopy times(6.3 ± 1.5);X-ray group 72 pedicle screws were flat single screw placement time was(6.6 ± 1.4)min operation,the average amount of bleeding(360.7 ± 20.6)ml operation,average operation time(134.8 ± 5.7)min,each operation average fluoroscopy times(12.7 ± 2.2);in the navigation group 76 pedicle screw placement,70 cases of success,6 one is not successful,two placement success,the success rate of onetime placement was 92.1%;fluoroscopy group 72 pedicle screws implanted successfully in 48 of them,24 time is not successful,two successful placement,one-time screw placement success rate of 66.7%.All patients postoperative CT pedicle screw placement,through CT scan showed a relationship between pedicle and pedicle screw and according to Richter classification assessment,navigation group: superior nail 60 pieces,good nail 16 pieces,no poor nail,superior nail accounted for all of the screws percentage was 78.9%,good nail accounted for percent ratio of 21.1%,no poor nail;perspective group were implanted in 72 pedicle screws,superior nail 36 pieces,good nail 32 pieces,poor nail 4 pieces,superior nail accounted for all of the screws percentage is 50%,good nail percentage was 44.4%,poor nail accounted for 5.6%.Good and bad nail nail were not caused by nerve roots and cauda equina,dural injury,cerebrospinal fluid leakage.In the wall of the pedicle wall or the actual found in intraoperative decompression of the spinal canal damage when only 6.Consistency in bilateral pedicle screw placement,through the measurement of vertebral pedicle screw and endplate angle similarity compared navigation group average degree L4(left 3.63±0.76 degrees,right 3.93±0.67 degrees),L5(left 3.35±0.62 degree,the right is 3.34±0.36 degrees)and S1(left 3.33±0.26 degrees,right 3.13±0.45 degrees);perspective group average degree L4(left 3.63±1.79 degrees,right 6.62±1.75 degrees),(left 6.85±165 degrees,right 4.02±1.87 degrees)of L5,S1(left 4.01±178 degrees,right 6.75±176 degrees).The navigation group in the operation time,bleeding volume and perspective were compared,by chi square test,there was no significant difference between the two groups(P>0.05);navigation group at the Shiumi Ne screw single screw insertion time is similar with X-ray group,the chi square test,two sets of single screw insertion time no significant difference(P>0.05);a success rate of Shiumi Ne screw,the chi square test,the results of the two groups was statistically significant(P<0.05),the navigation group than in X-ray group significantly improved the success rate of one-time placement;in contrast to the screw nail top percentage and insertion accuracy,by chi square test(R*C)(P<0.05),there was statistical significance,the navigation group had significantly advantage;postoperative radiographs assessment of lumbar bilateral Shiumi Ne screws through consistency,consistency measurement on both sides of Shiumi Ne screw and lumbar endplate angle changes,through the t test Display the navigation group have obvious advantages,the navigation group on both sides of high consistency of the vertebral pedicle.Conclusion: Clinical surgical treatment of lumbar degenerative disease,using computerassisted pedicle screw placement,can significantly improve the pedicle screw placement accuracy,which can significantly reduce intraoperative fluoroscopy times,pedicle screw placement time,operative time.This study showed that the use of computer navigation assisted pedicle screw placement in the treatment of lumbar degenerative disease,can significantly improve the screw accuracy.Non-performing rate of screw placement were significantly lower.Safer operation,less radiation exposure time and frequencies indicated in this research,shows the value of navigation surgery in the clinical application. |
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