[논문]Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery

Eom, Ki Seong; Park, Eun Sung; Kim, Dae Won; Park, Jong Tae; Yoon, Kwon-Ha

doi:10.20408/jti.2021.0010

Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery 원문보기

Journal of trauma and injury : JTI, v.35 no.1, 2022년, pp.12 - 18

Eom, Ki Seong (Department of Neurosurgery, Wonkwang University School of Medicine) , Park, Eun Sung (Department of Neurosurgery, Wonkwang University School of Medicine) , Kim, Dae Won (Department of Neurosurgery, Wonkwang University School of Medicine) , Park, Jong Tae (Department of Neurosurgery, Wonkwang University School of Medicine) , Yoon, Kwon-Ha (Department of Radiology, Wonkwang University Hospital)

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Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7-S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

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표/그림 (5)

그림 Fig. 1. Mobile cone-beam computed tomography using MX-CBT1240 (Phion 2.0; NanoFocusRay, Iksan, Korea).
표 Table 1. Heary classification for pedicle screw breaches on postoperative computed tomography imaging [6]
표 Table 2. Demographic characteristics of patients
표 Table 3. Number of pedicle screws at each vertebral level and the frequency of breaches on postoperative mobile cone-beam computed tomography images based on the Heary classification
$Fig. 2. (A) Lumbar axial and (B) sagittal computed tomography showing an acute burst fracture of the L1 body with mild depression and a previous posterior lumbar interbody fusion with pedicular screw fixation at L3-L4. (C) Lumbar axial and (D) sagittal magnetic resonance images showing an acute burst fracture with a partial tear of the posterolateral ligament complex at L1 and an epidural hematoma extending from T11 to L2/3. (E) Postoperative axial, (F) coronal, and (G) sagittal mobile cone-beam computed tomography showing violation of the lateral pedicle by the screw shaft and the screw tip entirely within the vertebral body of the right L1. The screw shaft and the tip of the left L1 are entirely within the pedicle and vertebral body without a breach. The patient provided written informed consent for the publication of the research details and clinical images.$ 그림 Fig. 2. (A) Lumbar axial and (B) sagittal computed tomography showing an acute burst fracture of the L1 body with mild depression and a previous posterior lumbar interbody fusion with pedicular screw fixation at L3-L4. (C) Lumbar axial and (D) sagittal magnetic resonance images showing an acute burst fracture with a partial tear of the posterolateral ligament complex at L1 and an epidural hematoma extending from T11 to L2/3. (E) Postoperative axial, (F) coronal, and (G) sagittal mobile cone-beam computed tomography showing violation of the lateral pedicle by the screw shaft and the screw tip entirely within the vertebral body of the right L1. The screw shaft and the tip of the left L1 are entirely within the pedicle and vertebral body without a breach. The patient provided written informed consent for the publication of the research details and clinical images.

참고문헌 (18)

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Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery 원문보기

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Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery 원문보기

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