CT scanning combined with three-dimensional visualization technology in the positioning of microchannel microchannel in lumbar spinal stenosis pathway

doi:10.3877/cma.j.issn.2095-9141.2024.04.005

Abstract

Abstract:

Objective

To explore the application value of CT scanning combined with threedimensional visualization technology in preoperative positioning for microchannel lumbar posterior approach surgery.

Methods

Clinical data of 113 patients with spinal stenosis who underwent microchannel lumbar posterior approach surgery from June 2018 to March 2021 in Neurosurgery Department of the 900^th Hospital of Joint Logistics Force were collected. Patients were randomly divided into experimental group (58 cases) and control group (55 cases) using a random number table. The experimental group underwent preoperative CT scanning with preoperative positioning using Mimics threedimensional visualization technology.The control group underwent X-ray anterior-posterior scanning with preoperative positioning using metal paper clips placed in the waist. The accuracy of preoperative positioning,the number of intraoperative fluoroscopies,the number of intraoperative channel adjustments,and the duration of surgery were compared between the two groups.Pain visual analogue score (VAS)and Oswestry dysfunction index (ODI) scores were used to assess the improvement in pain and functional disability 1 d before surgery and 1 week,3 months,and 1 year after surgery.

Results

The intraoperative fluoroscopy frequency, intraoperative channel adjustment frequency, and surgery duration of the experimental group were lower than those of the control group, and the difference was statistically significant (P＜0.05); There was no statistically significant difference in the accuracy of positioning between the two groups (P＞0.05). The VAS and ODI scores of the experimental group were lower than those of the control group 1 week after surgery, and the difference was statistically significant (P＜0.05);There was no statistically significant difference in VAS and ODI scores between the two groups at 3 months and 1 year after surgery(P＞0.05).The postoperative VAS and ODI scores of both groups gradually decreased with the prolongation of time, and the differences at each time point were statistically significant (P＜0.05).

Conclusion

In preoperative positioning for microchannel lumbar posterior approach surgery, CT scanning combined with Mimics three-dimensional visualization technology has more advantages than traditional X-ray positioning technology and is considered as an ideal preoperative positioning method.

Key words: Three-dimensional visualization technology, Microscope channel, CT scanning, Preoperative positioning

Bin Chi, Liangfeng Wei, Shousen Wang. CT scanning combined with three-dimensional visualization technology in the positioning of microchannel microchannel in lumbar spinal stenosis pathway[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(04): 220-225.

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Figures/Tables 5

Fig.1 Schematic diagram of preoperative CT localization in the experimental group

Fig.2 Schematic diagram of the surgical approach simulation in the experimental group

Tab.1 Comparison of general data between two groups

项目	试验组（n=58）	对照组（n=55）	χ ²/t/Z值	P值
性别			0.011	0.915
男性	30	29
女性	28	26
年龄（岁， $\bar{x}$ ±s）	57.53±8.19	57.68±8.36	0.098	0.922
病变节段分布			0.005	0.997
L3/4	1	1
L4/584	43	41
L5/S1	14	13
临床表现			0.262	0.877
伴下肢神经根性疼痛	30	31
伴下肢感觉异常	11	9
伴下肢乏力或间歇性跛行	17	15
体质量指数（kg/m²， $\bar{x}$ ±s）	22.39±3.24	22.30±3.13	0.021	0.983
术前VAS评分[分，M（P₂₅，P₇₅）]	5.00（4.43，5.70）	5.00（4.50，5.10）	-0.124	0.901
术前ODI评分[分，M（P₂₅，P₇₅）]	32.00（28.00，35.13）	31.90（26.00，37.80）	-0.302	0.763

Tab.1 Comparison of general data between two groups

项目	试验组（n=58）	对照组（n=55）	χ ²/t/Z值	P值
性别			0.011	0.915
男性	30	29
女性	28	26
年龄（岁， $\bar{x}$ ±s）	57.53±8.19	57.68±8.36	0.098	0.922
病变节段分布			0.005	0.997
L3/4	1	1
L4/584	43	41
L5/S1	14	13
临床表现			0.262	0.877
伴下肢神经根性疼痛	30	31
伴下肢感觉异常	11	9
伴下肢乏力或间歇性跛行	17	15
体质量指数（kg/m²， $\bar{x}$ ±s）	22.39±3.24	22.30±3.13	0.021	0.983
术前VAS评分[分，M（P₂₅，P₇₅）]	5.00（4.43，5.70）	5.00（4.50，5.10）	-0.124	0.901
术前ODI评分[分，M（P₂₅，P₇₅）]	32.00（28.00，35.13）	31.90（26.00，37.80）	-0.302	0.763

Tab.2 Comparison of surgical parameters between two groups

组别	例数	术中透视次数[次，M（P₂₅，P₇₅）]	术中通道调整次数[次，M（P₂₅，P₇₅）]	手术时间[min，M（P₂₅，P₇₅）]	定位准确（是/否）
试验组	58	1（1，1）	1（1，1）	45.17（43.64，46.15）	57/1
对照组	55	2（1，2）	2（1，2）	52.64（46.83，53.73）	52/3
Z/χ²值		-5.254	-6.637	-6.437	1.151
P值		＜0.001	＜0.001	＜0.001	0.283

Tab.3 Comparison of VAS and ODI scores between two groups at different postoperative time points [score,M(P₂₅,P₇₅)]

组别	例数	VAS评分					ODI评分
组别	例数	术后1周	术后3个月	术后1年	H值	P值	术后1周	术后3个月	术后1年	H值	P值
试验组	58	1.00（0.70，1.60）	0.50（0.70，0.90）^a	0.28（0.45，0.70）^ab	48.494	＜0.001	20.00（15.08，21.23）	16.00（12.08，18.10）^a	13.00（8.80，15.30）^ab	35.513	＜0.001
对照组	55	1.60（1.10，2.10）	0.50（0.70，1.00）^a	0.20（0.40，0.60）^ab	82.364	＜0.001	20.00（17.80，26.00）	16.00（12.00，18.00）^a	12.00（8.90，15.60）^ab	60.649	＜0.001
Z值		-3.299	-0.130	-0.408			-2.431	-0.273	-0.101
P值		0.001	0.896	0.683			0.015	0.785	0.920

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