Name: cone beam intraoperative computed tomography-based image guidance for minimally invasive transforaminal interbody fusion
Uploaded: 2019-08-06T14:00:00
Description: Watch this Scientific Journal Video about Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion at JoVE.com

我们要感谢UCSF医疗中心和神经外科,允许我们进行这一努力。

所有程序和研究活动都是经机构审查委员会批准(CHR #17-21909)进行的。
1. 术前准备
<ol><li>诱导患者进行一般麻醉,用胸部支撑和髋垫将患者放在杰克逊桌上。</li>
	<li>准备和窗帘病人的背部以通常无菌的方式。</li>
</ol>2. 外科手术
<ol><li>使用 #15 刀片在 PSIS 对计划 TLIF 的一侧进行小刺切口。</li>
	<li>将活检针穿过刺切口放入硅中,以收获骨髓吸气(<strong class="xfig"...

<ol>
	<li>Mobbs, R. J., Phan, K., Malham, G., Seex, K., Rao, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+interbody+fusion:+techniques,+indications+and+comparison+of+interbody+fusion+options+including+PLIF,+TLIF,+MI-TLIF,+OLIF/ATP,+LLIF+and+ALIF.">Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.</a> J Spine Surg. 1 (1), 2-18 (2015).</li><li>Foley, K. T., Holly, L. T., Schwender, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+lumbar+fusion.">Minimally invasive lumbar fusion.</a> Spine (Phila Pa 1976). 28, S26-S35 (2003).</li><li>Foley, K. T., Lefkowitz, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+in+minimally+invasive+spine+surgery.">Advances in minimally invasive spine surgery.</a> Clin Neurosurg. 49, 499-517 (2002).</li><li>Schwender, J. D., Holly, L. T., Rouben, D. P., Foley, K. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+transforaminal+lumbar+interbody+fusion+(TLIF):+technical+feasibility+and+initial+results.">Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results.</a> J Spinal Disord Tech. 18 Suppl, S1-S6 (2005).</li><li>Lee, K. H., Yue, W. M., Yeo, W., Soeharno, H., Tan, S. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+radiological+outcomes+of+open+versus+minimally+invasive+transforaminal+lumbar+interbody+fusion.">Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion.</a> Eur Spine J. 21 (11), 2265-2270 (2012).</li><li>Peng, C. W., Yue, W. M., Poh, S. Y., Yeo, W., Tan, S. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+radiological+outcomes+of+minimally+invasive+versus+open+transforaminal+lumbar+interbody+fusion.">Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion.</a> Spine (Phila Pa 1976). 34 (13), 1385-1389 (2009).</li><li>Schizas, C., Tzinieris, N., Tsiridis, E., Kosmopoulos, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+versus+open+transforaminal+lumbar+interbody+fusion:+evaluating+initial+experience.">Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience.</a> Int Orthop. 33 (6), 1683-1688 (2009).</li><li>Seng, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Five-year+outcomes+of+minimally+invasive+versus+open+transforaminal+lumbar+interbody+fusion:+a+matched-pair+comparison+study.">Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study.</a> Spine (Phila Pa 1976). 38 (23), 2049-2055 (2013).</li><li>Shunwu, F., Xing, Z., Fengdong, Z., Xiangqian, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+transforaminal+lumbar+interbody+fusion+for+the+treatment+of+degenerative+lumbar+diseases.">Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases.</a> Spine (Phila Pa 1976). 35 (17), 1615-1620 (2010).</li><li>Singh, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+perioperative+cost+analysis+comparing+single-level+minimally+invasive+and+open+transforaminal+lumbar+interbody+fusion).">A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion).</a> Spine J. 14 (8), 1694-1701 (2014).</li><li>Wong, A. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+transforaminal+lumbar+interbody+fusion+(MI-TLIF):+surgical+technique,+long-term+4-year+prospective+outcomes,+and+complications+compared+with+an+open+TLIF+cohort.">Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): surgical technique, long-term 4-year prospective outcomes, and complications compared with an open TLIF cohort.</a> Neurosurg Clin N Am. 25 (2), 279-304 (2014).</li><li>Clark, J. C., Jasmer, G., Marciano, F. F., Tumialan, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+transforaminal+lumbar+interbody+fusions+and+fluoroscopy:+a+low-dose+protocol+to+minimize+ionizing+radiation.">Minimally invasive transforaminal lumbar interbody fusions and fluoroscopy: a low-dose protocol to minimize ionizing radiation.</a> Neurosurg Focus. 35 (2), E8 (2013).</li><li>Ringel, F., Villard, J., Ryang, Y. M., Meyer, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigation,+robotics,+and+intraoperative+imaging+in+spinal+surgery.">Navigation, robotics, and intraoperative imaging in spinal surgery.</a> Adv Tech Stand Neurosurg. 41, 3-22 (2014).</li><li>Overley, S. C., Cho, S. K., Mehta, A. I., Arnold, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigation+and+Robotics+in+Spinal+Surgery:+Where+Are+We+Now.">Navigation and Robotics in Spinal Surgery: Where Are We Now.</a> Neurosurgery. 80, S86-S99 (2017).</li><li>Abdullah, K. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+exposure+to+the+spine+surgeon+in+lumbar+and+thoracolumbar+fusions+with+the+use+of+an+intraoperative+computed+tomographic+3-dimensional+imaging+system.">Radiation exposure to the spine surgeon in lumbar and thoracolumbar fusions with the use of an intraoperative computed tomographic 3-dimensional imaging system.</a> Spine (Phila Pa 1976). 37 (17), E1074-E1078 (2012).</li><li>Gelalis, I. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+pedicle+screw+placement:+a+systematic+review+of+prospective+in+vivo+studies+comparing+free+hand,+fluoroscopy+guidance+and+navigation+techniques.">Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques.</a> Eur Spine J. 21 (2), 247-255 (2012).</li><li>Nottmeier, E. W., Bowman, C., Nelson, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgeon+radiation+exposure+in+cone+beam+computed+tomography-based,+image-guided+spinal+surgery.">Surgeon radiation exposure in cone beam computed tomography-based, image-guided spinal surgery.</a> Int J Med Robot. 8 (2), 196-200 (2012).</li><li>Park, P., Foley, K. T., Cowan, J. A., Marca, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+pedicle+screw+fixation+utilizing+O-arm+fluoroscopy+with+computer-assisted+navigation:+Feasibility,+technique,+and+preliminary+results.">Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results.</a> Surg Neurol Int. 1, 44 (2010).</li><li>Van de Kelft, E., Costa, F., Vander Planken, D., Schils, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+multicenter+registry+on+the+accuracy+of+pedicle+screw+placement+in+the+thoracic,+lumbar,+and+sacral+levels+with+the+use+of+the+O-arm+imaging+system+and+StealthStation+Navigation.">A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation.</a> Spine (Phila Pa 1976). 37 (25), E1580-E1587 (2012).</li><li>Kim, T. T., Johnson, J. P., Pashman, R., Drazin, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+Invasive+Spinal+Surgery+with+Intraoperative+Image-Guided+Navigation.">Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation.</a> Biomed Res Int. 2016, 5716235 (2016).</li><li>Kim, M. C., Chung, H. T., Cho, J. L., Kim, D. J., Chung, N. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subsidence+of+polyetheretherketone+cage+after+minimally+invasive+transforaminal+lumbar+interbody+fusion.">Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion.</a> J Spinal Disord Tech. 26 (2), 87-92 (2013).</li><li>Kim, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+Invasive+Transforaminal+Lumbar+Interbody+Fusion+Using+Expandable+Technology:+A+Clinical+and+Radiographic+Analysis+of+50+Patients.">Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Technology: A Clinical and Radiographic Analysis of 50 Patients.</a> World Neurosurg. 90, 228-235 (2016).</li><li>Malham, G. M., Parker, R. M., Blecher, C. M., Seex, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+and+classification+of+subsidence+after+lateral+interbody+fusion+using+serial+computed+tomography.">Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography.</a> J Neurosurg Spine. , 1-9 (2015).</li><li>Safaee, M. M., Oh, T., Pekmezci, M., Clark, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+exposure+with+hybrid+image-guidance-based+minimally+invasive+transforaminal+lumbar+interbody+fusion.">Radiation exposure with hybrid image-guidance-based minimally invasive transforaminal lumbar interbody fusion.</a> J Clin Neurosci. , (2017).</li><li>Yu, E., Khan, S. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+less+invasive+spine+surgery+result+in+increased+radiation+exposure?+A+systematic+review.">Does less invasive spine surgery result in increased radiation exposure? A systematic review.</a> Clin Orthop Relat Res. 472 (6), 1738-1748 (2014).</li><li>Villard, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+exposure+to+the+surgeon+and+the+patient+during+posterior+lumbar+spinal+instrumentation:+a+prospective+randomized+comparison+of+navigated+versus+non-navigated+freehand+techniques.">Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques.</a> Spine (Phila Pa 1976). 39 (13), 1004-1009 (2014).</li><li>Tabaraee, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+cone+beam-computed+tomography+with+navigation+(O-ARM)+versus+conventional+fluoroscopy+(C-ARM):+a+cadaveric+study+comparing+accuracy,+efficiency,+and+safety+for+spinal+instrumentation.">Intraoperative cone beam-computed tomography with navigation (O-ARM) versus conventional fluoroscopy (C-ARM): a cadaveric study comparing accuracy, efficiency, and safety for spinal instrumentation.</a> Spine (Phila Pa 1976). 38 (22), 1953-1958 (2013).</li><li>Theologis, A. A., Burch, S., Pekmezci, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placement+of+iliosacral+screws+using+3D+image-guided+(O-Arm)+technology+and+Stealth+Navigation:+comparison+with+traditional+fluoroscopy.">Placement of iliosacral screws using 3D image-guided (O-Arm) technology and Stealth Navigation: comparison with traditional fluoroscopy.</a> Bone Joint J. 98-B. 98-B (5), 696-702 (2016).</li><li>Mendelsohn, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+and+surgeon+radiation+exposure+during+spinal+instrumentation+using+intraoperative+computed+tomography-based+navigation.">Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation.</a> Spine J. 16 (3), 343-354 (2016).</li><li>Shin, B. J., Njoku, I. U., Tsiouris, A. J., Hartl, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigated+guide+tube+for+the+placement+of+mini-open+pedicle+screws+using+stereotactic+3D+navigation+without+the+use+of+K-wires:+technical+note.">Navigated guide tube for the placement of mini-open pedicle screws using stereotactic 3D navigation without the use of K-wires: technical note.</a> J Neurosurg Spine. 18 (2), 178-183 (2013).</li><li>Lian, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+3D+Airo(R)+Navigation+for+Minimally+Invasive+Transforaminal+Lumbar+Interbody+Fusion.">Total 3D Airo(R) Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion.</a> Biomed Res Int. 2016, 5027340 (2016).</li><li>Navarro-Ramirez, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+Navigation+in+Spine+Surgery;+A+Concise+Guide+to+Eliminate+Fluoroscopy+Using+a+Portable+Intraoperative+Computed+Tomography+3-Dimensional+Navigation+System.">Total Navigation in Spine Surgery; A Concise Guide to Eliminate Fluoroscopy Using a Portable Intraoperative Computed Tomography 3-Dimensional Navigation System.</a> World Neurosurg. 100, 325-335 (2017).</li></ol>

描述的过程有几个关键步骤。第一个关键步骤是注册过程。参考电弧必须放置在实心骨中,并应正确定向,以避免在必要时干扰 S1 脚踏螺钉放置。第二个关键步骤是执行术中CT扫描后保持导航的准确性,这可以通过识别正常的解剖结构并确认正确的定位来完成。应定期验证准确性。也许所述技术的一个限制是,在操作过程中可能会无意中更改导航。注册派生自手术台上的固定患者位置。因此,患者或参?...

TLIF 是考虑用于退行性椎间盘疾病和脊柱裂的体间融合时可用的几种选项之一。TLIF 技术最初是针对与较传统的后腰间体间融合 (PLIF) 方法相关的并发症而开发的。更具体地说,TLIF最大限度地减少了神经元素的回缩,从而降低了神经根损伤的风险以及硬膜撕裂的风险,这可能导致脑脊液持续泄漏。作为一种单边方法,TLIF技术也可以更好地保存后元素1的正常解剖结构。TLIF可以执行开放(O-TLIF)或微创(MIS-TLIF),和MIS-TLIF已被证明是一个多功能和流行的治疗腰椎退行性疾病和脊柱炎2,3,4。与O-TLIF相比,MIS-TLIF与减少失血、缩短住院时间、减少麻醉使用有关;患者报告和放射学结果测量在开放和MIS方法之间也相似,因此表明MIS-TLIF是一个同样有效但可能较少病态的程序5,6,7, 8,9,10,11.
然而,传统MIS技术的一个经常限制是严重依赖荧光镜,使病人、外科医生和手术室工作人员暴露在非平凡的辐射剂量和荧光镜检查时间之间,范围从46-147 s12。然而,最近,对术中CT制导导航的使用进行了研究,有几种不同的系统可供使用,并在文献中描述了包括O-arm/Stealth、Airo Mobile和Stryker脊柱导航系统。13,14这种类型的导航技术已被证明能够产生精确的脚踏螺钉放置,同时将外科医生的辐射风险降至最低,外科医生15、16、17、1819.在本文中,我们介绍了一种MIS-TLIF的新技术,该技术利用基于图像引导的螺杆放置,然后采用传统的荧光镜检查,然后进行保持架和杆放置。此策略有可能提高脚踏螺钉放置的速度和准确性,同时最大限度地减少对患者和手术室工作人员的辐射暴露。

<table border="0" cellpadding="0" cellspacing="0" style="width:899px;" width="899">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">O-arm intraoperative CT</td>
			<td style="width:288px;">Medtronic, Minneapolis, MN</td>
			<td style="width:136px;"></td>
			<td style="width:191px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Stealth Navigation System</td>
			<td style="width:288px;">Medtronic, Minneapolis, MN</td>
			<td style="width:136px;"></td>
			<td style="width:191px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Jamshidi Needles</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td>for bone marrow biopsy</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Cefazolin&#160;</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td>antibiotic.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Vicryl Sutures</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Steri-Strips</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td>for skin closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">telfa dressing</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">tegaderm</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td>for dressing</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Jackson table</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">15-blade</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">High-speed bone drill</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Tubular dilator</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">K-wires</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Reduction towers</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">TLIF retractor</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">2 or 3 mm Kerrison rongeur</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Woodson elevator</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Disc shaver and distractor</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Fluoroscopy</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Allograft cellular bone matrix</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Interbody cage</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Rod</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Soft lumbar brace</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">X-ray</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:284px;">Patient-controlled analgesia pump</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

cone beam intraoperative computed tomography-based image guidance for minimally invasive transforaminal interbody fusion

跨腰椎间质融合 (TLIF) 通常用于治疗脊柱狭窄、退行性椎间盘疾病和脊柱炎。微创手术 (MIS) 方法已应用于此技术,相关减少估计失血 (EBL)、住院时间以及感染率,同时保留传统开放式手术的结果。以前的 MIS TLIF 技术涉及大量的荧光镜检查,使患者、外科医生和手术室工作人员受到非平凡的辐射暴露,尤其是复杂的多级程序。我们提出了一种利用术中计算机断层扫描 (CT) 扫描来帮助放置脚踏螺钉的技术,然后是传统的荧光镜检查,以确认保持架放置。患者以标准方式定位,参考弧位于后部上部脊柱 (PSIS) 中,然后是术中 CT 扫描。这允许通过每侧一英寸的皮肤切口,基于图像指导放置脚踏螺钉。与在这一阶段需要大量荧光成像的传统MIS-TLIF不同,现在可以在不向患者或手术室工作人员造成任何额外辐射的情况下进行手术。完成面部切除术和椎间盘切除术后,最终TLIF保持架放置通过荧光镜检查确认。该技术有可能减少操作时间,并最大限度地减少总辐射暴露。

50名患者在单外科医生(AC)下接受了这项技术的手术。平均年龄为53岁(29-84岁),其中30名妇女和20名男子。患者呈现以下病理学:脊柱狭窄(n=45),脊柱炎(n=29),面囊肿(n=5),退行性脊柱侧弯(n=3)和cauda儿皮综合征(n=1)。症状为42例背部和腿部疼痛,2例仅背部疼痛,6例为下肢放射病。在10个病例中,患者曾接受病理学级别的手术。结果在表 1中汇总。
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Watch this Scientific Journal Video about Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion at JoVE.com

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

本文的目的是为微创的跨体间融合提供图像指导。

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

这种方法可以帮助回答神经外科领域的关键问题，因为它的主要优点是利用术中导航和尽量减少所需的荧光镜和相关辐射效应。诱导全身麻醉后，将患者放在杰克逊桌子上的易发位置，并配有胸部支撑和热垫，并按照标准方案准备和覆盖患者的背部。使用数字15刀片，使一个小刺切口在后优越的腹椎反面到计划的跨毛腰间体融合的一侧，并放置一个Jamshidi针通过刺切口到氦收获骨髓吸气。将导航参考框架驱动到后上级脊柱的轨迹中，将参考弧等同侧侧向后上级侧腔脊柱，用暴露的参考弧线覆盖无菌窗帘。使用导航系统执行术中计算机断层扫描，以规划双子柱螺钉轨迹。然后使用配备导航钻头的高速钻头和两到三毫米位来固定双底柱，并在跨面腰间间融合对面的K线上放置带切割塔的可切割式石柱螺钉。要确定膨胀器沿圆盘空间的轨迹，请使用导航系统定向管状扩张器，以在跨面腰间融合中放置其他扩张器。通过导航确认缩回器定位，并使用高速钻头在解剖显微镜下根据标准方案进行层切除术和面部切除术，注意 laminotomy的横向边界是面关节的中边，而层切除术的中边是层对内边缘。使用伍德森电梯解剖从杜拉的韧带火焰。一旦达到这一点，使用两或三毫米的克里森龙，以去除骨的韧带火焰。如果需要反向减压，将缩回器角过中线，并使用"边缘"去除反侧层膜、韧带松弛和肥大面胶囊的底面。再次使用导航来识别光盘空间的轨迹，以便进行安全彻底的椎间盘切除术，并使用剃须刀和干扰器准备光盘空间。完成减压和面部切除术后，可以轻轻缩回钙囊以可视化光盘空间。可以使用图像制导确认轨迹。钙囊被轻轻地收回医疗和数字15刀片用于执行去样手术。切除术是使用垂体龙，治疗和拉丝的组合完成。切除术完成后，使用间歇性荧光镜来可视化体间试验放置过程中所需的分心程度，以确保端板的保存。现在，将异体细胞骨基质与收获的自体骨髓吸气混合，并小心地将混合物打包到光盘空间中。插入体间保持架，通过侧侧和外侧荧光镜确认保持架位置。一旦跨毛腰间体间融合完成，放置剩余的脚轮螺钉，并小心地驱动预弯杆通过螺旋腰筋膜下方的螺钉头使用定期荧光镜检查，以确认已实现适当的杆长度。在用锁定螺钉固定杆之前，轻轻压缩棒以诱导洛德病。获得最终的氟镜检查后，用零聚乳胶910缝合关闭胸腔筋膜，用3-0多糖蛋白910缝合关闭皮下组织。然后用皮肤闭合条近似皮肤边缘，并在伤口上涂抹防水敷料。在这项具有代表性的研究中，50名患者提出了各种病理，其中10人曾接受过病理水平的手术。在一半的患者中，使用了左侧方法，在大多数患者中融合了单一水平，在多水平融合患者中观察到的手术时间显著增加。观看此视频后，您应该对微创跨毛腰间融合程序有一个良好的理解，使用图像指导放置的卵石螺钉和最小荧光镜的体间保持架的位置。

Research

JoVE Journal

Medicine

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

双相位锥束CT看看，到达，并在药物洗脱珠Transarterial化疗栓塞治疗原发性肝癌

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

科研

医学

Minimally Invasive Establishment of Murine Orthotopic Bladder Xenografts

微创建立小鼠原位膀胱移植瘤的

Orthotopic bladder cancer xenografts are the gold standard to study molecular cellular manipulations and new therapeutic agents&#160;in vivo. Suitable ...

Encapsulation Thermogenic Preadipocytes for Transplantation into Adipose Tissue Depots

封装产热前脂肪细胞移植到脂肪组织仓库

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular ...

Minimally Invasive Transverse Aortic Constriction in Mice

微创横向主动脉缩窄小鼠

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

重建显微外科缺血再灌注损伤研究的临床前大鼠模型

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

与便携式刻度学监视器一起使用时，评估卡光采样线兼容性和准确性

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

时间分辨、动态计算机断层扫描血管造影术，用于主动脉内漏的表征和 通过 2D-3D 融合成像进行治疗指导

In the United States, more than 80% of all abdominal aortic aneurysms are treated by endovascular aortic aneurysm repair (EVAR). The endovascular approach ...

Sample Preparation for Computed Tomography-based Three-dimensional Visualization of Murine Hind-limb Vessels

基于计算机断层扫描的小鼠后肢血管三维可视化的样品制备

Blood vessels are complex networks with tree-like structures, and vascular networks are essential for maintaining both circulation and maintaining organ ...