To Study On The Application Of Three Dimensional(3D) Imaging Of The Lumbar For Implanting Pedicle Screw With MSCT (Multi-section Spiral CT)

Objective: By comparing the result after operation and thequality of implantation of two groups under different conditionsto scientific study the position and effect of MSCT volumerendering, VR in implanting lumbar pedicle screw to sure theclinical application value, to ensure the accuracy of the screwinsertion, to provide reference for clinical application, to enrichthe substance of evidential medical science.Materials and Methods:Between August 17,2004 andAugust 27,2006, 63 cases of pedicle screw implantation werecollected and divided into two groups (A and B). A group: theredimensional(3D) imaging of the lumbar and data of the pediclewhich mimic planting screw. To measure correlated data to decide the inserting angular, length and diameter of the screw.All the cases applied scanning parameter as thick 1.25mm, pitch0.75 to get axial view image and lumbar 3D reconstruction, andthen measure the length of mimic screw tract, sagittal sectionangle, SSA in 3D imaging of single vertebral body and height ofpedicle, width of pedicle. According these parameter to decidethe length,diameter and inserting angular. B group casesunderwent operation without 3D imaging of lumbar and thecorrelated parameter of pedicle. Other preoperative prepare andoperative progress were same as A group. Totally 164 screwswere fixed in 37cases of group A. Totally 104 screws were fixedin 26 cases of group B. All screws were observed about its'positions and directions with X-ray and CT analyzes afteroperation to evaluate the clinical effect of operation. To discussthe position and effect of 3D imaging of lumbar by comparingthe result after operation and the quality of implantation of twogroups.Results:All of 63cases were completed operationssuccessfully. Totally 164 screws were fixed in 37cases of groupA. The highest position of screw entrance was the firstlumbar(L1) and the lowest was the first sacral vertebrae (S1).After operation the pedicle of all cases were rechecked with CT scanning. The positions of 159 screws were good and 5 screwsdeviated slightly, and there was no complication of systemanervosum. Totally 104 screws were fixed in 26 cases of group B.After operation the pedicle of all cases were rechecked withposteroanterior and lateral X-ray film The positions of 80screws were good and 24 screws deviated slightly, leakage ofcerebrospinal fluid happened in 2 cases, and injury of nerve rootin 1 case of them. To evaluate the effect of operation, group Ahave a advantage than group B. After operations pedicle screwplacements were evaluated, group A surpass group B. Therewere significant difference between two groups.Conclusions: 1. MSCT volume rendering is a helpfultechnique in clinical preoperative measuring the 3D anatomicparameters of the lumbars. It provided advantageous evidencefor inserting screws accurately and selecting appropriate lengthand diameter of pedicle screw, and satisfactory effect ofoperation. 2. To measure parameter according MSCT VR of 3Dimaging before operation and to monitor accurately theinformation of inserting during operation is a reliable method, itis worth to generalizing for practical application.