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Objective To evaluate the accuracy and safety of pedicle screw placement for spinal deformity under intraoperative CT-as-sisted.Methods The clinical data of 28 patients with spinal deformity,who underwent intraoperative CT-assisted placement of pedicle screws in our hospital from March 2014 to March 2017,were analyzed retrospectively.Intraoperative CT-assisted placement of pedicle screws was to observe the position of pedicle screws and adjust the screw position.The safety of pedicle screw fixation was assessed by the postoperative complications.Results All 28 patients of scoliosis were successfully performed surgery.A total of 402 pedicle screws were placed in the spines and the placements of 64 screws of them were adjusted according to intraoperative CT findings.Of 402 screws,377 were placed in the pedicles,13 by grade 1 pedicle breach,8 by grade 2 pedicle breach and 4 by grade 3 pedicle breach according to Gertzbein-Robbins classifi-cation of pedicle screw placement accuracy.No complication was directly related to the screws placement.No patient required reoperation due to the misplacement of the pedicle screws.Conclusion Intraoperative cone-beam CT scan can help the surgeon improve the accuracy and safety of pedicle screw placement for spinal deformity with less complication.
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Objective To investigate the value of intraoperative X-ray guided and CT guided percutaneous biopsy in the diagnosis of thoracic and lumbar space occupying lesions.Methods A total of 97 patients with thoracic and lumbar space occupying lesions who were not diagnosed clinically in our hospital from May 2011 to July 2016 were retrospectively analyzed.All patients underwent percutaneous vertebral biopsy under the guidance of Artis-Zeego robot in the Artis-Zeego complex operating room of our hospital.Thoracic vertebral body biopsy in patients with a total of 46 cases were divided into T group,in which X-ray guided percutaneous biopsy in 25 cases were divided into T-x group,CT guided percutaneous biopsy in 21 cases were divided into T-ct group.Lumbar puncture biopsy in patients with a total of 51 cases were divided into L group,in which X-ray guided percutaneous live review of 24 cases were divided into L-x group,CT guided percutaneous biopsy in 27 cases were divided into L-ct group.According to the packet respectively in X-ray or CT monitoring,the use of bone biopsy needle under local anesthesia,transpedicular approach for spinal lesions of bone amount,by changing the working path or direction bone biopsy needle of different diameter to save drilling samples which were immediately placed in 10％ formalin,specimens were sent for pathological examination and corresponding pathological and cytological examination.The success rate,diagnostic accuracy and complications of percutaneous biopsy were compared between the two groups in X-ray and CT guided percutaneous vertebral biopsy.Results T-x group of 25 patients,5 patients with puncture failure for intraoperative X-ray monitoring difficulties were transferred to puncture under the guidance of CT,the success rate of puncture was 80％ (20/25).Of the patients with success puncture,6 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy in T-x group was 70％ (14/20).The success rate of puncture in T-ct group was 100％,significantly higher than that of T-x group(P ＜ 0.05).In T-ct group,3 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy was 88.5 ％ (23/26),which was significantly higher than that of T-x group (P ＜ 0.05).In the L-x group,1 case with puncture failure for pain during the operation,the success rate of puncture was 95.8％ (23/24),patients of L-ct group were successfully punctured,the success rate was 100％,the difference between the two groups was not significant(P ＞ 0.05).In the L-x group,2 patients failed to confirm the diagnosis,the diagnostic total accuracy rate of L-x group was 87.5％ (21/23);of the L-ct group,1 cases failed to confirm the diagnosis,the diagnosis total accuracy rate of L-ct group was 96.3％ (26/27),the difference between two groups was not significant (P ＞ 0.05).Complications:In the T-x group,1 cases received additional local anesthetic after puncture for pain;1 patients had transient lower extremity paresthesia,and the symptoms were improved 1 weeks later;1 case with intraoperation puncture site paining was not alleviated and had to stop the puncture.All patients with CT guided biopsy had no complications.Conclusion CT and X-ray guided percutaneous biopsy has important significance in diagnosis and treatment of spinal lesions,and CT guided percutaneous biopsy is safer for thoracic lesions with higher diagnostic rate,while for lumbar lesions fluoroscopy,X-ray or CT guided percutaneous biopsy has the same security and diagnostic rate.
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Objective To discuss the clinical curative effect of percutaneous vertebroplasty(PVP)combined with percutaneous pedicle screw fixation for thoracolumbar fracture.Methods Retrospectively analyzed the clinical data of 43 patients with thoracolumbar fracture who underwent PVP combined with percutaneous pedicle screw fixation in our hospital from November 2015 to June 2017.Those patients included 28 males and 15 females,and the age of patients ranged from 50 to 66 years old,with an average age of(58.26 ±3.67)years old.The func-tional outcome were evaluated by VAS scores and ODI scores before and after the operation.The sagittal Cobb angle was used to evaluate the reduction of fracture.Results All these patients all successfully completed the operation,and there was no complications after operation.The operation time ranged from 60 to 126 min,with an average time of(96.07 ±15.69)min;the blood loss ranged from 60 to 180 min,with an average time of(113.26 ±24.7)min.All the patients were followed up for 4 to 23 months,with an average time of(12.07 ±4.01)months. The VAS score,ODI score and sagittal Cobb angle were significantly decreased in the last follow -up period compared with those before surgery,and the difference was statistically significant(P<0.05).Conclusion PVP combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture has smaller incision,less blood loss,shorter operation time and better improvement of local pain,func-tional movement and kyphosis.
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Objective To evaluate the accuracy and safety of screw placement position through second sacral alar -iliac(S2AI)with in-teroperative cone beam CT(CBCT)scan.Methods Collected 22 patients who underwent second sacral alar-iliac screw implant surgery in our hospital from June 2015 to June 2017.All the patients had intraoperative CBCT scan and conventional CT scan after operation.Regard the postoperative CT scan imageing as gold standard to assess the accuracy and safety of S 2AI screws position.The S2AI tract parameters were measured with intraoperative CBCT images and postoperative CT images respectively.Results There was no significant difference between the S2AI tract parameters which were measured with intraoperative CBCT images and postoperative CT images(P>0.05).Conclusion The intraoperative CBCT scan could accurately evaluate the position of S 2AI screws,as well as clarify the damage of the inner and outer plate of the iliac bone in the process of fixation.Compared with postoperative conventional CT scan,the intraoperative CBCT scan can potentially re-duce the reoperation rate.
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Objective To investigate the feasibility to execute percutaneous kyphoplasty(PKP) in the field comprehensive surgical shelter during kinds of natural disasters. Methods Five experimental pigs underwent PKP in a comprehensive surgical shelter during simulated natural disasters, and were observed for operating time, intraoperative blood loss, complications and postoperative survival rate. Results All the 5 pigs had the operations completed successfully with high postoperative performances in extremities motion and survival rate, and the mean operating time was(43±5.7)min and the mean intraoperative blood loss was (42±3.6)ml.Cement penetrated into the intervertebral space of one pig with satisfactory extremities motion,while no complications occurred in the other pigs.Conclusion The comprehensive surgical shelter proves to enable PKP,and thus extends emergency treatment to the frontier during simulated natural disasters.
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Objective To evaluate the safety and effectiveness of percutaneous alcohol embolization(PAE) combined with percutaneous vertebroplasty(PVP) for aggressive vertebral haemangiomas (AVHs) with epidural extension.Methods The data of 26 consecutive patients underwent PAE combined with PVP for the treatment of AVHs with epidural extension from October 2013 to November 2015 were analyzed retrospectively.The average follow-up time was (12.21 ± 1.34) months.The pain symptom before and after surgery were evaluated with a visual analogue scale (VAS).Results Pre-procedure mean VAS score was (7.23 ± 1.3) and the postoperative VAS score was (3.11 ± 1.9) at last follow-up.Ten patients (38.5％) remained asymptomatic.Eighty-eight percent of the patients with neurosensory disorders had complete regression of these symptoms.Two of the three patients with motor deficit did not show any improvement.No major complication was recorded.Conclusion PAE combined with PVP is a minimally invasive safe and effective therapeutic approach for AVH with epidural extension.This technique appears mainly effective for pain and neurosensory symptoms,but seems less effective for motor deficit relief.