Publication: Análisis de resultados de la colocación de tornillos transpediculares en instrumentación dorsolumbar con guía de neuronavegación
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2017-02-14
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Universidad Complutense de Madrid
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Abstract
La fijación transpedicular se ha utilizado durante décadas para estabilizar la columna dorsolumbar y se ha convertido en el pilar de la fusión espinal. A pesar de los avances técnicos, la colocación de tornillos transpediculares continúa asociándose a complicaciones, siendo la malposición de los tornillos la más frecuentemente descrita. Aunque los tornillos transpediculares fueron inicialmente colocados mediante la técnica clásica basada en el reconocimiento de referencias anatómicas, se han introducido nuevas técnicas asistidas. La fluoroscopia continúa siendo muy utilizada en la actualidad, pese a que ha mostrado algunos inconvenientes, como ofrecer únicamente imágenes en AP y lateral y asociarse a un incremento en la exposición a la radiación. La cirugía asistida por navegación proporciona una visualización multiplanar de la anatomía espinal a tiempo real. La navegación también tiene algunas desventajas, fundamentalmente el incremento del tiempo quirúrgico y el alto coste. Se han publicado altas tasas de precisión con las tres técnicas. Sin embargo, en nuestra amplia revisión de la literatura no hemos encontrado ningún estudio que compare los resultados de la precisión de la colocación valorada mediante TC postquirúrgica, entre la navegación basada en una TC preoperatoria y el control fluoroscópico...
Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades and it has become the mainstay of spinal fusion. Despite technical advances, pedicle screw insertion is still associated with potential complications, being screw misplacement the most frequently reported. Although pedicle screws were originally placed via the classic free-hand technique, which is based on vertebral bone landmarks for screw insertion, with the advances of technology and imaging, new techniques have been introduced, such assistive techniques include fluoroscopy guidance and navigation. Fluoroscopy and plain serial radiography are still commonly used, nevertheless it has some inconveniences. Fluoroscopy only captures images in the lateral and AP planes and has been associated with increased radiation exposure. Computer navigated surgery provides a simultaneous multiplanar visualization of spinal anatomy and allows virtually any surgical instrument to be tracked in relation to the displayed anatomy in real time. Navigation systems also have some drawback such as increased operating times and high cost associated with purchase and installation of an image-guided surgical suite...
Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades and it has become the mainstay of spinal fusion. Despite technical advances, pedicle screw insertion is still associated with potential complications, being screw misplacement the most frequently reported. Although pedicle screws were originally placed via the classic free-hand technique, which is based on vertebral bone landmarks for screw insertion, with the advances of technology and imaging, new techniques have been introduced, such assistive techniques include fluoroscopy guidance and navigation. Fluoroscopy and plain serial radiography are still commonly used, nevertheless it has some inconveniences. Fluoroscopy only captures images in the lateral and AP planes and has been associated with increased radiation exposure. Computer navigated surgery provides a simultaneous multiplanar visualization of spinal anatomy and allows virtually any surgical instrument to be tracked in relation to the displayed anatomy in real time. Navigation systems also have some drawback such as increased operating times and high cost associated with purchase and installation of an image-guided surgical suite...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 02/12/2015