1
|
Gauci MO. Patient-specific guides in orthopedic surgery. Orthop Traumatol Surg Res 2022; 108:103154. [PMID: 34838754 DOI: 10.1016/j.otsr.2021.103154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
The interest of patient-specific guides (PSGs) lies in reliable intraoperative achievement of preoperative planning goals. They are a form of instrumentation optimizing intraoperative precision and thus improving the safety and reproducibility of surgical procedures. Clinical superiority, however, has not been demonstrated. The various steps from design to implementation leave room for error, which needs to be known and controlled by the surgeon who is responsible for final outcome. Instituting large-scale patient-specific surgery requires management systems for guides and innovative implants which cannot be a simple extension of current practices. We shall approach the present state of knowledge regarding PSGs via 5 questions: (1) What is a PSG? Single-use instrumentation produced after preoperative planning, aiming exclusively to optimize procedural exactness. (2) How to use and assess PSGs in orthopedic surgery? Strict rules of use must be adhered to. Any deviation from the predefined objective is, necessarily, an error that must be identified as such. (3) Do PSGs provide greater surgical exactness? The contribution of PSGs varies greatly between procedures. Exactness is enhanced in the spine, in osteotomies around the knee and in bone-tumor surgery. In the shoulder, their contribution is seen only in complex cases. Data are sparse for hip replacement, and controversial for knee replacement. (4) What are the expected benefits of PSGs? As well as improving exactness, PSGs allow a lower radiation dose and shorter operating time. They also enable junior surgeons to train in techniques otherwise reserved to hyperspecialists. (5) How to include PSGs in everyday practice? As well as their potential clinical interest, PSGs involve deep changes in organization, equipment provision and economic model. LEVEL OF EVIDENCE: V; expert opinion.
Collapse
Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UCA), Hôpital Pasteur II, 30, voie Romaine, 06000 Nice, France.
| |
Collapse
|
2
|
Abstract
Rapid prototyping (RP), also known as three-dimensional printing (3DP), allows the rapid conversion of anatomical images into physical components by the use of special printers. This novel technology has also become a promising innovation for spine surgery. As a result of the developments in 3DP technology, production speeds have increased, and costs have decreased. This technological development can be used extensively in different parts of spine surgery such as preoperative planning, surgical simulations, patient-clinician communication, education, intraoperative guidance, and even implantable devices. However, similar to other emerging technologies, the usage of RP in spine surgery has various drawbacks that are needed to be addressed through further studies.
Collapse
Affiliation(s)
- Alpaslan Senkoylu
- Department of Orthopaedics and Traumatology, Gazi University, Besevler, Ankara, Turkey
| | - Ismail Daldal
- Department of Orthopaedics and Traumatology, Lokman Hekim Akay Hospital, Ankara, Turkey
| | - Mehmet Cetinkaya
- Department of Orthopaedics and Traumatology, Memorial Ankara Hospital, Ankara, Turkey
| |
Collapse
|
3
|
3D-printed navigation template in cervical spine fusion: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:389-401. [DOI: 10.1007/s00586-020-06601-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 06/28/2020] [Accepted: 09/05/2020] [Indexed: 12/19/2022]
|
4
|
Tong Y, Kaplan DJ, Spivak JM, Bendo JA. Three-dimensional printing in spine surgery: a review of current applications. Spine J 2020; 20:833-846. [PMID: 31731009 DOI: 10.1016/j.spinee.2019.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023]
Abstract
In recent years, the use of three-dimensional printing (3DP) technology has gained traction in orthopedic spine surgery. Although research on this topic is still primarily limited to case reports and small cohort studies, it is evident that there are many avenues for 3DP innovation in the field. This review article aims to discuss the current and emerging 3DP applications in spine surgery, as well as the challenges of 3DP production and limitations in its use. 3DP models have been presented as helpful tools for patient education, medical training, and presurgical planning. Intraoperatively, 3DP devices may serve as patient-specific surgical guides and implants that improve surgical outcomes. However, the time, cost, and learning curve associated with constructing a 3DP model are major barriers to widespread use in spine surgery. Considering the costs and benefits of 3DP along with the varying risks associated with different spine procedures, 3DP technology is likely most valuable for complex or atypical spine disorder cases. Further research is warranted to gain a better understanding of how 3DP can and will impact spine surgery.
Collapse
Affiliation(s)
- Yixuan Tong
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA
| | - Daniel James Kaplan
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA
| | - Jeffrey M Spivak
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA
| | - John A Bendo
- Spine Division, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, USA.
| |
Collapse
|
5
|
Jung YG, Lee S, Jeong SK, Kim M, Park JH. Subaxial Cervical Pedicle Screw in Traumatic Spinal Surgery. Korean J Neurotrauma 2020; 16:18-27. [PMID: 32395448 PMCID: PMC7192805 DOI: 10.13004/kjnt.2020.16.e13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/13/2020] [Indexed: 01/19/2023] Open
Abstract
In cases of unstable cervical traumatic lesions, the biomechanical superiority of the cervical pedicle screw (CPS) allows the lesion to be stabilized effectively. In this study, we review and summarize the indications, technical guidelines, and potential neurovascular complications and their prevention of the use of the CPS for trauma. For patients with fractured lamina or lateral mass, a CPS is reliable for stabilization. In addition, the CPS can penetrate through a linear cervical spinal pedicle fracture gap and could stabilize three-column injury. CPS reduce the range of surgical approach and preserve the motion segment using short-segment fixation. Fluoroscopy-guided CPS insertion is popular and cost-effective. Image-guided navigation systems improve accuracy. Three-dimensional template-guided CPS placement is simple to use. Most spine surgeons can perform laminoforaminotomy easily. Freehand technique that can be performed quickly without heavy equipment is suitable for emergency situation. Possible complications due to screw misplacement are vertebral artery injury owing to a laterally misplaced screw, dural sac or spinal cord injury from a medially misplaced screw, and nerve root injury caused by a superiorly or inferiorly misplaced screw. To prevent neurovascular complications, meticulous preoperative anatomical evaluation and following the five steps are most important.
Collapse
Affiliation(s)
- Yoon Gyo Jung
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Subum Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Kyun Jeong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeongjong Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Jung YG, Jung SK, Lee BJ, Lee S, Jeong SK, Kim M, Park JH. The Subaxial Cervical Pedicle Screw for Cervical Spine Diseases: The Review of Technical Developments and Complication Avoidance. Neurol Med Chir (Tokyo) 2020; 60:231-243. [PMID: 32295984 PMCID: PMC7246229 DOI: 10.2176/nmc.ra.2019-0189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed to review information on the subaxial cervical pedicle screw (CPS) including recent anatomical considerations, entry points, placement techniques, accuracy, learning curve, and complications. Relevant literatures were reviewed, and the authors’ experiences were summarized. The CPS is used for reconstruction of unstable cervical spine and achieves superior biomechanical stability compared to other fixation techniques. Various insertion and guidance techniques are established, among which, lateral fluoroscopy-assisted placement is the most common and cost-effective technique. Generally, placement under imaging guidance is more accurate than other techniques, and a three-dimensional template allows optimal trajectory for each pedicle regardless of intraoperative changes in spinal alignment. The free-hand technique using a curved pedicle probe without a funnel-like hole increases screw stability and reduces operation time, radiation exposure, and soft tissue injury. Compared to conventional lateral fluoroscopy-assisted placement, free-hand CPS placement by trained surgeons achieves superior accuracy comparable to that of image-guided navigation; in general, 30 training cases are sufficient for learning a safe and accurate technique for CPS placement. The complications of subaxial CPS are classified into three categories: complications due to screw misplacement, complications without screw misplacement, and others. Inexperienced surgeons may benefit from advanced techniques; however, the accuracy of CPS ultimately depends on the surgeon’s experience. Inexperienced surgeons should master the placement of the thoracolumbar pedicle screw in real practice and practice CPS insertion using cadavers. During the initial phase of the learning curve, careful preparation of surgery, reiterated identification, patterned safety steps, and supervision of the expert are necessary.
Collapse
Affiliation(s)
- Yoon Gyo Jung
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang Ku Jung
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine
| | - Byung Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience and Radiosurgery Hybrid Research Center, College of Medicine
| | - Subum Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seong Kyun Jeong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Myeongjong Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| |
Collapse
|
7
|
Yu C, Ou Y, Xie C, Zhang Y, Wei J, Mu X. Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:1. [PMID: 31900192 PMCID: PMC6942326 DOI: 10.1186/s13018-019-1510-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022] Open
Abstract
Background Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. Materials/Methods We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ2 test and I2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. Results This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20 ~ − 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 ~ − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). Conclusion The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.
Collapse
Affiliation(s)
- Chengqiang Yu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Chengxin Xie
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Yu Zhang
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China.
| | - Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China.
| |
Collapse
|
8
|
Tian Y, Zhang J, Liu T, Tang S, Chen H, Ding K, Hao D. A Comparative Study of C2 Pedicle or Pars Screw Placement with Assistance from a 3-Dimensional (3D)-Printed Navigation Template versus C-Arm Based Navigation. Med Sci Monit 2019; 25:9981-9990. [PMID: 31907341 PMCID: PMC6944189 DOI: 10.12659/msm.918440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Since C2 is adjacent to important nerves and blood vessels, the implantation risk of C2 internal fixation in this area is high and requires high accuracy. This study mainly discussed the application value of 3-dimensional (3D)-printed navigation template in C2 screw placement. Material/Methods A retrospective study compared 3D-printed navigation template-assisted screw placement (group A, n=32) and the C-arm based navigation-assisted screw placement group (group B, n=32). Group A was divided into 2 subgroups: A1 (C2 pedicle screw placement) and A2 (C2 pars screw placement); group B was divided into B1 (C2 pedicle screw placement) and B2 (C2 pars screw placement). The accuracy and safety of screw placement and clinical outcomes were evaluated. Results There were 64 C2 screws placed in group A, and 95.31% achieved a grade A accuracy rating, including 52 screws in group A1 (96.15% grade A) and 12 screws in group A2 (91.67% grade A). A total of 64 C2 screws were placed in group B, and 84.38% achieved a grade A accuracy rating, including 50 screws in group B1 (84.00% grade A) and 14 screws in group B2 (85.71% grade A). The accuracy of screw placement differed significantly between groups A and B (P=0.041) and between groups A1 and B1 (P=0.039) but not between groups A2 and B2 (P=0.636). The postoperative efficacy of the 2 groups was satisfactory. And there were no complications of blood vessels or nerves related to screw placement in either group. Conclusions Although 3D-printed navigation template-assisted and C-arm based navigation-assisted C2 pedicle and pars screw placement provided similar safety and clinical efficacy, 3D-printed navigation template technology achieved more accurate C2 pedicle screw placement.
Collapse
Affiliation(s)
- Ye Tian
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jianan Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Tuanjiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Shi Tang
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Hao Chen
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Keyuan Ding
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| |
Collapse
|
9
|
Borghi A, Ruggiero F, Tenhagen M, Schievano S, Ponniah A, Dunaway D, O'Hara J, Ong J, Britto JA. Design and manufacturing of a patient-specific nasal implant for congenital arhinia: Case report. JPRAS Open 2019; 21:28-34. [PMID: 32158883 PMCID: PMC7061611 DOI: 10.1016/j.jpra.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
Arhinia (congenital absence of the nose) is a congenital rare disease, which has been reported in less than 60 cases in the literature. It consists of the absence of external nose, nasal cavities and olfactory apparatus and is generally associated with midline defects, microphthalmia, blepharophimosis and hypotelorism. Aesthetic problems as well as associated functional anomalies can potentially impact on the development and interpersonal relationships of the child at a later stage in life. Arhinia requires extensive management in early life in order to ensure airway patency and protection by means of tracheostomy, and to allow adequate pharyngeal and feeding function to the child. Aesthetic issues are managed with reconstructive surgery or an external prosthesis. There is no previous description in Literature of internal prosthetic devices used to sequentially shape soft tissues in complex reconstruction. We present an example of design and manufacturing of a bespoke nose implant produced by means of 3D printing and directly assessed on-table by means of 3D surface scanning.
Collapse
Affiliation(s)
- Alessandro Borghi
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Federica Ruggiero
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Maik Tenhagen
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Silvia Schievano
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Allan Ponniah
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG. UK
| | - David Dunaway
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Justine O'Hara
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | | |
Collapse
|
10
|
Pijpker PAJ, Kraeima J, Witjes MJH, Oterdoom DLM, Coppes MH, Groen RJM, Kuijlen JMA. Accuracy Assessment of Pedicle and Lateral Mass Screw Insertion Assisted by Customized 3D-Printed Drill Guides: A Human Cadaver Study. Oper Neurosurg (Hagerstown) 2018; 16:94-102. [DOI: 10.1093/ons/opy060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/07/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Accurate cervical screw insertion is of paramount importance considering the risk of damage to adjacent vital structures. Recent research in 3-dimensional (3D) technology describes the advantage of patient-specific drill guides for accurate screw positioning, but consensus about the optimal guide design and the accuracy is lacking.
OBJECTIVE
To find the optimal design and to evaluate the accuracy of individualized 3D-printed drill guides for lateral mass and pedicle screw placement in the cervical and upper thoracic spine.
METHODS
Five Thiel-embalmed human cadavers were used for individualized drill-guide planning of 86 screw trajectories in the cervical and upper thoracic spine. Using 3D bone models reconstructed from acquired computed tomography scans, the drill guides were produced for both pedicle and lateral mass screw trajectories. During the study, the initial minimalistic design was refined, resulting in the advanced guide design. Screw trajectories were drilled and the realized trajectories were compared to the planned trajectories using 3D deviation analysis.
RESULTS
The overall entry point and 3D angular accuracy were 0.76 ± 0.52 mm and 3.22 ± 2.34°, respectively. Average measurements for the minimalistic guides were 1.20 mm for entry points, 5.61° for the 3D angulation, 2.38° for the 2D axial angulation, and 4.80° for the 2D sagittal angulation. For the advanced guides, the respective measurements were 0.66 mm, 2.72°, 1.26°, and 2.12°, respectively.
CONCLUSION
The study ultimately resulted in an advanced guide design including caudally positioned hooks, crosslink support structure, and metal inlays. The novel advanced drill guide design yields excellent drilling accuracy.
Collapse
Affiliation(s)
- Peter A J Pijpker
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten H Coppes
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
11
|
Wilcox B, Mobbs RJ, Wu AM, Phan K. Systematic review of 3D printing in spinal surgery: the current state of play. JOURNAL OF SPINE SURGERY 2017; 3:433-443. [PMID: 29057355 DOI: 10.21037/jss.2017.09.01] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.
Collapse
Affiliation(s)
- Ben Wilcox
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Ai-Min Wu
- Department of Spine Surgery, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, Zhejiang Spine Center, Wenzhou 325027, China
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| |
Collapse
|
12
|
Wu X, Liu R, Yu J, Lu L, Yang C, Shao Z, Ye Z. Deviation analysis for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. Proc Inst Mech Eng H 2017; 231:547-554. [PMID: 28056709 DOI: 10.1177/0954411916680382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical transarticular fixation is a technically demanding procedure. This study aimed to develop a safer and more accurate method for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. A total of 20 patients with C1/2 fractures and dislocations were recruited, and their computed tomography scans were evaluated. Under the assistance of the three-dimensional printed drilling guide, bilateral C1/2 pedicle screws were successfully placed in the three-dimensional C1/2 models. Then, sagittal and axial computed tomography scans were obtained, and the accuracy and safety of screw placement were evaluated based on X-Y-Z axis setup. The average depths for C1 and C2 pedicle screws were 30.1 ± 1.12 and 31.81 ± 0.85 mm on the left side and 29.54 ± 1.01 and 31.35 ± 0.27 mm on the right side, respectively. The average dimensional parameters for C1/C2 pedicle screw of both sides were measured and analyzed, which showed no statistically significant differences in the ideal and the actual entry points, inclined angles, and tailed angles. The method of developing a three-dimensional printed drilling guide is an easy and safe technique. This novel technique is applicable for C1/2 pedicle screw fixation; the potential use of the three-dimensional printed guide to place C1/2 pedicle screw is promising.
Collapse
Affiliation(s)
- Xinghuo Wu
- Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Liu
- Department of Orthopaedic Surgery, Puren Hospital of Wuhan, Wuhan University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Lu
- Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhewei Ye
- Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
13
|
Accuracy Assessment of Using Rapid Prototyping Drill Templates for Atlantoaxial Screw Placement: A Cadaver Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5075879. [PMID: 28004004 PMCID: PMC5149599 DOI: 10.1155/2016/5075879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/05/2016] [Indexed: 11/23/2022]
Abstract
Purpose. To preliminarily evaluate the feasibility and accuracy of using rapid prototyping drill templates (RPDTs) for C1 lateral mass screw (C1-LMS) and C2 pedicle screw (C2-PS) placement. Methods. 23 formalin-fixed craniocervical cadaver specimens were randomly divided into two groups. In the conventional method group, intraoperative fluoroscopy was used to assist the screw placement. In the RPDT navigation group, specific RPDTs were constructed for each specimen and were used intraoperatively for screw placement navigation. The screw position, the operating time, and the fluoroscopy time for each screw placement were compared between the 2 groups. Results. Compared with the conventional method, the RPDT technique significantly increased the placement accuracy of the C2-PS (p < 0.05). In the axial plane, using RPDTs also significantly increased C1-LMS placement accuracy (p < 0.05). In the sagittal plane, although using RPDTs had a very high accuracy rate (100%) in C1-LMS placement, it was not statistically significant compared with the conventional method (p > 0.05). Moreover, the RPDT technique significantly decreased the operating and fluoroscopy times. Conclusion. Using RPDTs significantly increases the accuracy of C1-LMS and C2-PS placement while decreasing the screw placement time and the radiation exposure. Due to these advantages, this approach is worth promoting for use in the Harms technique.
Collapse
|