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Cai H, Cai H, Wang Z. Application of 3D printing navigation system in pediatric epiphyseal complex lesion surgery. Comput Assist Surg (Abingdon) 2023; 28:2174045. [PMID: 36859782 DOI: 10.1080/24699322.2023.2174045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
To investigate 3D printing navigation system in pediatric epiphyseal complex lesion surgery. 10 children with epiphyseal complex lesions of the lower limb were recruited. After collecting imaging data such as CT and MRI in children with epiphyseal complex lesions of the lower limb, a three-dimensional model of bone was constructed using 3D printed computer modeling technologies for the localization of the lesion area. The extent of bone bridges was less than 30%, and all of them met the indications for bone bridge resection surgery. 3D printed navigation templates guided lesion resection. Epiphyseal block growth regulation with a figure-of-eight plate was also used in cases with preexisting abnormal alignment. During the operation, the average surgical incision was 4.0 cm, the bone bridge positioning was accurate, and the bone bridge tissue could be successfully and completely removed. As a result of follow-up, no cases had residual bone bridge tissue, no iatrogenic epiphyseal injury was found, and the epiphyseal plate was open in all children. 3D printing navigation system improved the accuracy of resection of lower limb epiphyseal complex lesions, significantly reduced the need for intraoperative fluoroscopy, avoided iatrogenic injury to the epiphyseal complex due to positioning errors, thereby reducing postoperative complications and considerably improving the prognosis of a series of lower limb epiphyseal complex lesion diseases in children.
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Affiliation(s)
- Haoqi Cai
- Department of Orthopedic, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haiqing Cai
- Department of Orthopedic, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Wang
- Department of Orthopedic, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Malikov A, Secen AE, Ocal O, Divanlioglu D, Belen AD, Dalgic A. Accuracy of Axis Drill Guides in the Cases of Atlantoaxial Instabilities Associated With High-Riding Vertebral Arteries, Narrow Pedicles, and Complex Deformities: Comparison of 3 Fixation Methods. World Neurosurg 2022; 168:e336-e343. [DOI: 10.1016/j.wneu.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022]
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Shi W, Aini M, Dang L, Kahaer A, Zhou Z, Wang Y, Maimaiti A, Wang S, Guo H, Rexiti P. Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine. Front Surg 2022; 9:1028276. [PMID: 36406344 PMCID: PMC9666697 DOI: 10.3389/fsurg.2022.1028276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Compared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof. METHODS Four human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement. RESULTS Twenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively. CONCLUSIONS We report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.
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Affiliation(s)
- Wenjie Shi
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Mijiti Aini
- Department of Orthopedics Second People's Hospital Kashgar District, Xinjiang Uygur Autonomous Region, Kashgar City, China
| | - Limin Dang
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhihao Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yixi Wang
- Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China,Correspondence: Paerhati Rexiti Hailong Guo
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi, China,Correspondence: Paerhati Rexiti Hailong Guo
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Pijpker PAJ, Kuijlen JMA, Tamási K, Oterdoom DLM, Vergeer RA, Rijtema G, Coppes MH, Kraeima J, Groen RJM. The Accuracy of Patient-Specific Spinal Drill Guides Is Non-Inferior to Computer-Assisted Surgery: The Results of a Split-Spine Randomized Controlled Trial. J Pers Med 2022; 12:jpm12071084. [PMID: 35887581 PMCID: PMC9317516 DOI: 10.3390/jpm12071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
In recent years, patient-specific spinal drill guides (3DPGs) have gained widespread popularity. Several studies have shown that the accuracy of screw insertion with these guides is superior to that obtained using the freehand insertion technique, but there are no studies that make a comparison with computer-assisted surgery (CAS). The aim of this study was to determine whether the accuracy of insertion of spinal screws using 3DPGs is non-inferior to insertion via CAS. A randomized controlled split-spine study was performed in which 3DPG and CAS were randomly assigned to the left or right sides of the spines of patients undergoing fixation surgery. The 3D measured accuracy of screw insertion was the primary study outcome parameter. Sixty screws inserted in 10 patients who completed the study protocol were used for the non-inferiority analysis. The non-inferiority of 3DPG was demonstrated for entry-point accuracy, as the upper margin of the 95% CI (−1.01 mm−0.49 mm) for the difference between the means did not cross the predetermined non-inferiority margin of 1 mm (p < 0.05). We also demonstrated non-inferiority of 3D angular accuracy (p < 0.05), with a 95% CI for the true difference of −2.30°−1.35°, not crossing the predetermined non-inferiority margin of 3° (p < 0.05). The results of this randomized controlled trial (RCT) showed that 3DPGs provide a non-inferior alternative to CAS in terms of screw insertion accuracy and have considerable potential as a navigational technique in spinal fixation.
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Affiliation(s)
- Peter A. J. Pijpker
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
- 3D-Lab, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence:
| | - Jos M. A. Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Katalin Tamási
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - D. L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Rob A. Vergeer
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Gijs Rijtema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Maarten H. Coppes
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Joep Kraeima
- 3D-Lab, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Rob J. M. Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
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Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
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Cao J, Zhang X, Liu H, Yao Z, Bai Y, Guo D, Feng L. 3D printed templates improve the accuracy and safety of pedicle screw placement in the treatment of pediatric congenital scoliosis. BMC Musculoskelet Disord 2021; 22:1014. [PMID: 34863150 PMCID: PMC8645104 DOI: 10.1186/s12891-021-04892-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background Three-dimensional (3-D) printed guidance templates are being increasingly used in spine surgery. The purpose of this study was to determine if 3D printed navigation templates can improve the accuracy of pedicle screw placement and decrease the complication rate compared to freehand screw placement in the treatment of children with congenital scoliosis. Methods The records of pediatric patients with congenital scoliosis treated at our hospital from January 2017 to January 2019 were retrospectively reviewed. Patients were divided into those where a 3D printed guidance templated was used and those in which the freehand method was used for pedicle screw placement. The accuracy rate of pedicle screw placement, surgical outcomes, and complications were compared between groups. Results A total of 67 children with congenital scoliosis were included (43 males and 24 females; mean age of 4.13 ± 2.66 years; range, 2–15 years). There were 34 children in the template-assisted group and 33 in the freehand group. The excellent accuracy rate of pedicle screw placement was significantly higher in the template-assisted group (96.10% vs. 88.64%, P = 0.007). The main Cobb angle and kyphosis angle were similar between the 2 groups preoperatively and postoperatively (all, P > 0.05), and in both groups both angles were significantly decreased after surgery as compared to the preoperative values (all, P < 0.001). The degree of change of the Cobb angle of the main curve and kyphosis angle were not significantly different between the 2 groups. There were no postoperative complications in the template group and 4 in the freehand group (0% vs. 12.12%; P = 0.009). All 4 patients with complications required revision surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04892-4.
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Affiliation(s)
- Jun Cao
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Xuejun Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China.
| | - Haonan Liu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Ziming Yao
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Yunsong Bai
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Dong Guo
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Lei Feng
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
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Critical analysis for a safe design of 3D printed Patient-Specific Surgical Guides (PSSG) for pedicle screw insertion in spinal deformities. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Wen Z, Lu T, He X, Li J, Zang Q, Wang Y, Gao Z, Gu P. Accuracy of cervical pedicle screw placement with four different designs of rapid prototyping navigation templates: a human cadaveric study. Comput Assist Surg (Abingdon) 2021; 26:49-57. [PMID: 33929922 DOI: 10.1080/24699322.2021.1919210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Due to the high perforation rate of cervical pedicle screw placement, we have designed four different types of rapid prototyping navigation templates to enhance the accuracy of cervical pedicle screw placement. METHODS Fifteen human cadaveric cervical spines from C2 to C7 were randomly divided into five groups, with three specimens in each group. The diameter of pedicle screw used in this study was 3.5 mm. Groups 1-4 were assisted by the two-level template, one-level bilateral template, one-level unilateral template and one-level point-contact template, respectively. Group 5 was without any navigation template. After the surgery, the accuracy of screw placement in the five groups was evaluated using postoperative computed tomographic scans to observe whether the screw breached the pedicle cortex. RESULTS A total of 180 pedicle screws were inserted without any accidents. The accuracy rate was 75%, 100%, 100%, 91.7%, and 63.9%, respectively, from Groups 1 to 5. All the template groups were significantly higher than Group 5, though the two-level navigation template group was significantly lower than the other three template groups. The operation time was 4.72 ± 0.28, 4.81 ± 0.29, 5.03 ± 0.35, 8.42 ± 0.36, and 10.05 ± 0.52 min, respectively, from Groups 1 to 5. The no template and point-contact procedures were significantly more time-consuming than the template procedures. CONCLUSION This study demonstrated that four different design types of navigation templates achieved a higher accuracy in assisting cervical pedicle screw placement than no template insertion. However, the two-level template's accuracy was the lowest compared to the other three templates. Meanwhile, these templates avoided fluoroscopy during the surgery and decreased the operation time. It is always very challenging to translate cadaveric studies to clinical practice. Hence, the one-level bilateral, unilateral, and point-contact navigation templates designed by us need to be meticulously tested to verify their accuracy and safety.
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Affiliation(s)
- Zhijing Wen
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Teng Lu
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Xijing He
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Jialiang Li
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Quanjin Zang
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Yibin Wang
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Zhengchao Gao
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
| | - Pengzhen Gu
- Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xincheng District, Shannxi, People's Republic of China
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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]
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Gu Y, Yao Q, Xu Y, Zhang H, Wei P, Wang L. A Clinical Application Study of Mixed Reality Technology Assisted Lumbar Pedicle Screws Implantation. Med Sci Monit 2020; 26:e924982. [PMID: 32647106 PMCID: PMC7370579 DOI: 10.12659/msm.924982] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background This was a prospective comparative study of mixed reality (MR) technology assisted lumbar pedicle screws placement and traditional lumbar pedicle screws placement. Material/Methods Fifty cases of lumbar pedicle screws placement were randomly divided into 2 groups: 25 cases with MR technology in group A, and 25 cases without MR technology in group B. All patients had their scores on the Oswestry disability index (ODI) of low back pain and the visual analog scale (VAS) of the affected lower limb recorded at pre-operation. Blood loss, operative duration, success rate of first penetration by tap, and number of times C-arm fluoroscopy was performed were recorded at intraoperation. The postoperative drainage was recorded. The ODI of low back pain and VAS of the affected lower limb were recorded at 1, 3, and 6 months after operation. Results Group A had less bleeding, shorter operation time, higher success rate of first penetration by tap, and fewer times using C-arm fluoroscopy at intraoperation (P<0.05). There was significant difference in ODI scores and VAS scores at 1 mouth after operation (P<0.05). The postoperative drainage of group A was less than group B (P<0.05). The implantation accuracy of group A was higher than group B (P<0.05). The postoperative recovery rate of low back pain of group A was faster than group B (P<0.05). Conclusions The safety of spinal surgery and implantation accuracy of pedicle screw fixation system could be increased by MR technology.
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Affiliation(s)
- Yue Gu
- The Third Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Qingqiang Yao
- Department of Orthopedic, Nanjing First Hospital, Nanjing, Jiangsu, China (mainland)
| | - Yan Xu
- Department of Orthopedic, Nanjing First Hospital, Nanjing, Jiangsu, China (mainland)
| | - Huikang Zhang
- Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Peiran Wei
- The Third Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Liming Wang
- Department of Orthopedic, Nanjing First Hospital, Nanjing, Jiangsu, China (mainland)
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Vissarionov SV, Kokushin DN, Khusainov NO, Kartavenko KA, Avila-Rodriguez MF, Somasundaram SG, Kirkland CE, Tarasov VV, Aliev G. Comparing the Treatment of Congenital Spine Deformity Using Freehand Techniques In Vivo and 3D-Printed Templates In Vitro (Prospective-Retrospective Single-Center Analytical Single-Cohort Study). Adv Ther 2020; 37:402-419. [PMID: 31755038 DOI: 10.1007/s12325-019-01152-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemivertebrae excision with local posterior instrumentation is the most common technique for treatment of patients with congenital spine deformity-it is performed at a very young age. We conducted a comparative analysis for accuracy of pedicle screw positioning in infants with congenital scoliosis of the thoracolumbar area inserted using freehand technique in vivo and 3D-printed guiding templates in vitro. METHODS The study analyzes the results of 10 surgically treated patients with congenital deformity of the thoracolumbar spine due to vertebrae failure of formation. These patients were included in group 1 (in vivo) comprising six boys and four girls with a mean age of 3 years 8 months (2 years 2 months-6 years 8 month). Group 2 (in vitro) consisted of 27 plastic 3D-printed models of congenitally deformed spine of the same 10 patients in which screws were placed using 3D-printed guiding templates. The accuracy of screw position was assessed using computer tomography data performed postoperatively with Gertzbein-Robbins classification. RESULTS Results of our study show that screw insertion using 3D-printed guiding templates during surgical treatment of infants with congenital spine deformities is more accurate than using freehand technique (96.3% vs. 78.8% p = 0.011). CONCLUSION The data show that this method of screw insertion is very promising and can be used in surgical treatment of infants with congenital spine deformities.
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Naddeo F, Fontana C, Naddeo A, Cataldo E, Cappetti N, Narciso N. Novel design for a customized, 3D‐printed surgical template for thoracic spinal arthrodesis. Int J Med Robot 2019; 15:e2005. [DOI: 10.1002/rcs.2005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Naddeo
- Department of Industrial EngineeringUniversity of Salerno Fisciano Italy
| | - Carlotta Fontana
- Department of Industrial EngineeringUniversity of Salerno Fisciano Italy
| | - Alessandro Naddeo
- Department of Industrial EngineeringUniversity of Salerno Fisciano Italy
| | - Emilio Cataldo
- Department of Industrial EngineeringUniversity of Salerno Fisciano Italy
- R&D DepartmentTechno DESIGN S.r.l. Battipaglia Italy
| | - Nicola Cappetti
- Department of Industrial EngineeringUniversity of Salerno Fisciano Italy
| | - Nicola Narciso
- “Testa‐Collo” Department“San Giovanni di Dio e Ruggi di Aragona” University Hospital Salerno Italy
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Tukkapuram VR, Kuniyoshi A, Ito M. A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation. Spine Surg Relat Res 2019; 3:126-135. [PMID: 31435564 PMCID: PMC6690082 DOI: 10.22603/ssrr.2018-0055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/30/2018] [Indexed: 12/02/2022] Open
Abstract
Cervical spine instrumentation is evolving with an aim of stabilizing traumatic and non-traumatic cases of the cervical spine with a beneficial reduction, better biomechanical strength, and a strong construct with minimal intraoperative, as well as immediate and late postoperative complications. The evolution from interspinous wiring till cervical pedicle screws has changed the outlook in treating the cervical spine pathologies with maximum 3D stability, decreasing the duration of postoperative immobilization and hospital stay. Some complications associated with the use of cervical pedicle screw can be catastrophic. This review article discusses the morphometry of cervical pedicle; indications, biomechanical superiority, tricks, and pitfalls of cervical pedicle screw; complications and technical advancements in targeting safe surgery; and future directions of cervical pedicle screw instrumentation.
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Affiliation(s)
| | - Abumi Kuniyoshi
- Department of orthopaedics, Sapporo Orthopaedic Hospital, Sapporo, Japan
| | - Manabu Ito
- Department of orthopaedics, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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15
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Hirsiger S, Schweizer A, Miyake J, Nagy L, Fürnstahl P. Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy. Hand (N Y) 2018; 13:627-636. [PMID: 28895433 PMCID: PMC6300182 DOI: 10.1177/1558944717726135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical planning of corrective osteotomies is traditionally based on conventional radiographs and clinical findings. In the past 10 years, 3-dimensional (3D) preoperative planning approaches with patient-specific guides have been developed. However, the application of this technology to posttraumatic deformities of the metacarpals and phalangeal bones has not yet been investigated. Our goal was to evaluate the feasibility of the surgical application to the latter and to evaluate the extent and precision of correction. METHODS We present results of 6 patients (8 osteotomies) treated with phalangeal or metacarpal corrective osteotomy. Deformities were located in the third ray in 1, fourth ray in 3, and fifth ray in 4 cases. Six malunited metacarpal bones (1 intra-articular) and 2 deformed proximal phalanges were treated. Computer-based 3D preoperative planning using the contralateral hand as a template allowed the production of 3D-printed patient-specific guides that were used intraoperatively for navigation. The precision of the reduction was assessed using pre- and postoperative computed tomography by comparing the postoperative bone model with the preoperatively simulated osteotomy. Range of motion and grip strength were documented pre- and postoperatively. RESULTS The mean follow-up time was 6 months (range: 5-11 months). Rotational deformity was reduced from a mean of 10.0° (range: 7.2°-19.3°) preoperatively to 2.3° (range: 0.7°-3.7°) postoperatively, and translational incongruency decreased from a mean of 1.4 mm (range: 0.7-2.8 mm) to 0.4 mm (range: 0.1-0.9 mm). CONCLUSION Preliminary results indicate that a precise reduction for corrective osteotomies of metacarpal and phalangeal bones can be achieved by using 3D planning and patient-specific guides.
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Affiliation(s)
| | | | | | | | - Philipp Fürnstahl
- University of Zurich, Switzerland,Philipp Fürnstahl, Department of
Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse
340, Zürich 8008, Switzerland.
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16
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Thayaparan GK, Owbridge MG, Thompson RG, D'Urso PS. Designing patient-specific 3D printed devices for posterior atlantoaxial transarticular fixation surgery. J Clin Neurosci 2018; 56:192-198. [DOI: 10.1016/j.jocn.2018.06.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/24/2018] [Indexed: 11/25/2022]
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17
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Novel Procedure for Designing and 3D Printing a Customized Surgical Template for Arthrodesis Surgery on the Sacrum. Symmetry (Basel) 2018. [DOI: 10.3390/sym10080334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this article, the authors propose a novel procedure for designing a customized 3D-printed surgical template to guide surgeons in inserting screws into the sacral zone during arthrodesis surgeries. The template is characterized by two cylindrical guides defined by means of trajectories identified, based on standard procedure, via an appropriate Computer-Aided-Design (CAD)-based procedure. The procedure is based on the definition of the insertion direction by means of anatomical landmarks that enable the screws to take advantage of the maximum available bone path. After 3D printing, the template adheres perfectly to the bone surface, showing univocal positioning by exploiting the foramina of the sacrum, great maneuverability due to the presence of an ergonomic handle, as well as a break system for the two independent guides. These features make the product innovative. Thanks to its small size and the easy anchoring, the surgeon can simply position the template on the insertion area and directly insert the screws, without alterations to standard surgical procedures. This has the effect of reducing the overall duration of the surgery and the patient’s exposure to X-rays, and increasing both the safety of the intervention and the quality of the results.
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19
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Affiliation(s)
| | - Raju Vaishya
- Indraprastha Apollo Hospitals, New Delhi 94, Sukhdev Vihar Delhi, New Delhi, 110025, India
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20
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Gruijthuijsen C, Colchester R, Devreker A, Javaux A, Maneas E, Noimark S, Xia W, Stoyanov D, Reynaerts D, Deprest J, Ourselin S, Desjardins A, Vercauteren T, Vander Poorten E. Haptic Guidance Based on All-Optical Ultrasound Distance Sensing for Safer Minimally Invasive Fetal Surgery. JOURNAL OF MEDICAL ROBOTICS RESEARCH 2018; 3:10.1142/S2424905X18410015. [PMID: 30820482 PMCID: PMC6390942 DOI: 10.1142/s2424905x18410015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
By intervening during the early stage of gestation, fetal surgeons aim to correct or minimize the effects of congenital disorders. As compared to postnatal treatment of these disorders, such early interventions can often actually save the life of the fetus and also improve the quality of life of the newborn. However, fetal surgery is considered one of the most challenging disciplines within Minimally Invasive Surgery (MIS), owing to factors such as the fragility of the anatomic features, poor visibility, limited manoeuvrability, and extreme requirements in terms of instrument handling with precise positioning. This work is centered on a fetal laser surgery procedure treating placental disorders. It proposes the use of haptic guidance to enhance the overall safety of this procedure and to simplify instrument handling. A method is described that provides effective guidance by installing a forbidden region virtual fixture over the placenta, thereby safeguarding adequate clearance between the instrument tip and the placenta. With a novel application of all-optical ultrasound distance sensing in which transmission and reception are performed with fibre optics, this method can be used with a sole reliance on intraoperatively acquired data. The added value of the guidance approach, in terms of safety and performance, is demonstrated in a series of experiments with a robotic platform.
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Affiliation(s)
| | - Richard Colchester
- Department of Medical Physics & Biomedical Engineering, University College London, UK
| | - Alain Devreker
- Department of Mechanical Engineering, KU Leuven, Belgium
| | - Allan Javaux
- Department of Mechanical Engineering, KU Leuven, Belgium
| | - Efthymios Maneas
- Department of Medical Physics & Biomedical Engineering, University College London, UK
| | - Sacha Noimark
- Department of Medical Physics & Biomedical Engineering, University College London, UK
| | - Wenfeng Xia
- Department of Medical Physics & Biomedical Engineering, University College London, UK
| | - Danail Stoyanov
- Centre for Medical Imaging Computing, University College London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, UK
| | | | - Jan Deprest
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, KU Leuven, Belgium
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, UK
| | - Sebastien Ourselin
- Centre for Medical Imaging Computing, University College London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, UK
| | - Adrien Desjardins
- Department of Medical Physics & Biomedical Engineering, University College London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, UK
| | - Tom Vercauteren
- Department of Medical Physics & Biomedical Engineering, University College London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, UK
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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.
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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
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Cai H, Liu Z, Wei F, Yu M, Xu N, Li Z. 3D Printing in Spine Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:345-359. [PMID: 30306494 DOI: 10.1007/978-981-13-1396-7_27] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the past 5 years, the application of 3D printing technology in the field of spine surgery had obtained enormous and substantial progress. Among which, vertebral skeleton model (including lesion model) printing has been widely used in clinical application due to its relatively simple technology and low cost. It shows practical value and becomes popular as the reference of clinical education, auxiliary diagnosis, communication between doctor and patient, and the planning of surgical approaches as well as the reference of more accurate operation in surgery. On the basis of vertebral skeleton model printing, it can be used to design and make navigation template to guide internal fixation screw, which also obtains some remarkable clinical effects. However, 3D printing technology has a more profound influence on spine surgery. The part with full expectation is undoubtedly the clinical application of 3D printing microporous metal implant and personalized implant as well as the clinical application of 3D printing biological materials in the future.
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Affiliation(s)
- Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zihe Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
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23
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Pan Y, Lü GH, Kuang L, Wang B. Accuracy of thoracic pedicle screw placement in adolescent patients with severe spinal deformities: a retrospective study comparing drill guide template with free-hand technique. 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 2017; 27:319-326. [PMID: 29234883 DOI: 10.1007/s00586-017-5410-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 09/20/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with severe spinal deformities often have small pedicle diameters, and pedicle dimensions vary between segments and individuals. Free-hand pedicle screw placement can be inaccurate. Individualized drill guide templates may be used, but the accuracy of pedicle screw placement in severe scoliosis remains unknown. The accuracy of drill guide templates and free-hand technique for the treatment of adolescent patients with severe idiopathic scoliosis are compared in this study. METHODS This study included 37 adolescent patients (mean age 16.4 ± 1.3 years) with severe idiopathic scoliosis treated surgically at a single spine center between January 2014 and June 2017. Spinal deformities were corrected using posterior pedicle screw fixation. Patients in group I were treated with rapid prototype drill guide template technique (20 patients; 396 screws) and patients in group II were treated with free-hand technique (17 patients; 312 screws). Outcomes that included operative time, correction rate, and the incidence and distribution of screw misplacement were evaluated. RESULTS Operative time in group I was 283 ± 22.7 min compared to 285 ± 25.8 min in group II (p = 0.89). The scoliosis correction rate was 55.0% in group I and 52.9% in group II (p = 0.33). Based on both axial and sagittal reconstruction images, the accuracy rate of pedicle screw placement was 96.7% in group I and 86.9% in group II (p = 0.000). CONCLUSION The drill guide template technique has potential to offer more accurate and thus safer placement of pedicle screws than free-hand technique in the treatment of severe scoliosis in adolescents.
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Affiliation(s)
- Yue Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - G H Lü
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
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24
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Azimifar F, Hassani K, Saveh AH, Ghomsheh FT. A medium invasiveness multi-level patient's specific template for pedicle screw placement in the scoliosis surgery. Biomed Eng Online 2017; 16:130. [PMID: 29137676 PMCID: PMC5686850 DOI: 10.1186/s12938-017-0421-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Several methods including free-hand technique, fluoroscopic guidance, image-guided navigation, computer-assisted surgery system, robotic platform and patient’s specific templates are being used for pedicle screw placement. These methods have screw misplacements and are not always easy to be applied. Furthermore, it is necessary to expose completely a large portions of the spine in order to access fit entirely around the vertebrae. Methods In this study, a multi-level patient’s specific template with medium invasiveness was proposed for pedicle screw placement in the scoliosis surgery. It helps to solve the problems related to the soft tissues removal. After a computer tomography (CT) scan of the spine, the templates were designed based on surgical considerations. Each template was manufactured using three-dimensional printing technology under a semi-flexible post processing. The templates were placed on vertebras at four points—at the base of the superior-inferior articular processes on both left–right sides. This helps to obtain less invasive and more accurate procedure as well as true-stable and easy placement in a unique position. The accuracy of screw positions was confirmed by CT scan after screw placement. Results The result showed the correct alignment in pedicle screw placement. In addition, the template has been initially tested on a metal wire series Moulage (height 70 cm and material is PVC). The results demonstrated that it could be possible to implement it on a real patient. Conclusions The proposed template significantly reduced screw misplacements, increased stability, and decreased the sliding & the intervention invasiveness.
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Affiliation(s)
- Farhad Azimifar
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kamran Hassani
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Amir Hossein Saveh
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, Ergonomics Department, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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25
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Shao ZX, Wang JS, Lin ZK, Ni WF, Wang XY, Wu AM. Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide. PeerJ 2017; 5:e3564. [PMID: 28717599 PMCID: PMC5511502 DOI: 10.7717/peerj.3564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 11/20/2022] Open
Abstract
Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD) lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments) of L1-L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy) and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05). Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.
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Affiliation(s)
- Zhen-Xuan Shao
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Jian-Shun Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Zhong-Ke Lin
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Wen-Fei Ni
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Ai-Min Wu
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
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Jiang L, Dong L, Tan M, Qi Y, Yang F, Yi P, Tang X. A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study. Med Sci Monit 2017; 23:1325-1333. [PMID: 28301445 PMCID: PMC5365048 DOI: 10.12659/msm.900066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Atlantoaxial posterior pedicle screw fixation has been widely used for treatment of atlantoaxial instability (AAI). However, precise and safe insertion of atlantoaxial pedicle screws remains challenging. This study presents a modified drill guide template based on a previous template for atlantoaxial pedicle screw placement. Material/Methods Our study included 54 patients (34 males and 20 females) with AAI. All the patients underwent posterior atlantoaxial pedicle screw fixation: 25 patients underwent surgery with the use of a modified drill guide template (template group) and 29 patients underwent surgery via the conventional method (conventional group). In the template group, a modified drill guide template was designed for each patient. The modified drill guide template and intraoperative fluoroscopy were used for surgery in the template group, while only intraoperative fluoroscopy was used in the conventional group. Results Of the 54 patients, 52 (96.3%) completed the follow-up for more than 12 months. The template group had significantly lower intraoperative fluoroscopy frequency (p<0.001) and higher accuracy of screw insertion (p=0.045) than the conventional group. There were no significant differences in surgical duration, intraoperative blood loss, or improvement of neurological function between the 2 groups (p>0.05). Conclusions Based on the results of this study, it is feasible to use the modified drill guide template for atlantoaxial pedicle screw placement. Using the template can significantly lower the screw malposition rate and the frequency of intraoperative fluoroscopy.
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Affiliation(s)
- Lianghai Jiang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland).,Graduate School of Peking Union Medical College, Beijing, China (mainland)
| | - Liang Dong
- Department of Spinal Surgery, Hong Hui Hospital, Xi'an, Shanxi, China (mainland)
| | - Mingsheng Tan
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland).,Graduate School of Peking Union Medical College, Beijing, China (mainland)
| | - Yingna Qi
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland)
| | - Feng Yang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland)
| | - Ping Yi
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland)
| | - Xiangsheng Tang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, China (mainland)
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An automatic and patient-specific algorithm to design the optimal insertion direction of pedicle screws for spine surgery templates. Med Biol Eng Comput 2017; 55:1549-1562. [PMID: 28160218 DOI: 10.1007/s11517-017-1627-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
Many diseases of the spine require surgical treatments that are currently performed based on the experience of the surgeon. For pedicle arthrodesis surgery, two critical factors must be addressed: Screws must be applied correctly and exposure to harmful radiation must be avoided. The incorrect positioning of the screws may cause operating failures that lead to subsequent reoperations, an increase in the overall duration of surgery and, therefore, more harmful, real-time X-ray checks. In this paper, the authors solve these problems by developing a method to realize a customized surgical template that acts as a drilling template. The template has two cylindrical guides that follow a correct trajectory previously calculated by means of an automatic algorithm generated on the basis of a vertebra CAD model for a specific patient. The surgeon sets the template (drilling guides) on the patient's vertebra and safely applies the screws. Three surgical interventions for spinal stabilization have been performed using the template. These have had excellent results with regard to the accuracy of the screw positioning, reduction of the overall duration of the intervention, and reduction of the number of times the patient was exposed to X-rays.
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Merc M, Recnik G, Krajnc Z. Lumbar and sacral pedicle screw placement using a template does not improve the midterm pain and disability outcome in comparison with free-hand method. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:583-589. [DOI: 10.1007/s00590-017-1904-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
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Azimifar F, Hassani K, Saveh AH, Tabatabai Ghomshe F. A low invasiveness patient’s specific template for spine surgery. Proc Inst Mech Eng H 2016; 231:143-148. [DOI: 10.1177/0954411916682770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Free-hand pedicle screw placement is still conventional in surgery, although it has potentially high risks. The surgical procedures such as pedicle screw placement are usually designed based on medical imaging, but during surgery, the procedures are not normally followed due to the fact that some points are missed in two-dimensional images and seen only during surgery. In this regards, some highly accurate computer-assisted systems have been proposed and are currently used. Moreover, it is possible to reduce or completely avoid hand working by applying modern digital technology. Therefore, using these technologies has remarkable advantages. In this study, we have presented a new approach of pedicle screw placement in the lumbar and sacral regions using a specific drill guide template. The template was created by additive manufacturing technology and was verified in a clinical study as well. The main aim of this research includes the following: design, analyze, manufacture and evaluate the accuracy of a new patient-specific drill guide template, for lumbar pedicle screw placement, and compare the template to the free-hand technique under fluoroscopy supervision. Our results show that the incidence of cortex perforation is substantially reduced compared to existing methods. Finally, we believe that this approach remarkably lowers the incidence of cortex perforation and could be potentially used in clinical applications, particularly in certain selected cases.
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Affiliation(s)
- Farhad Azimifar
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kamran Hassani
- Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Amir Hossein Saveh
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Tabatabai Ghomshe
- Pediatric Neurorehabilitation Research Center, Ergonomics Department, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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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.
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Jiang L, Dong L, Tan M, Yang F, Yi P, Tang X. Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg 2016; 136:1483-1490. [PMID: 27531494 DOI: 10.1007/s00402-016-2530-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Posterior atlantoaxial pedicle screw fixation is an effective technique for atlantoaxial instability (AAI). However, because of the complex anatomy of the cranio-cervical junction, it remains challenging to insert atlantoaxial pedicle screw precisely and safely. A novel drill guide template was designed for atlantoaxial pedicle screw placement in this study. The purpose of this study is to quantitatively evaluate the accuracy of atlantoaxial pedicle screw placement using the novel drill guide template. MATERIALS AND METHODS Between June 2014 and September 2015, 32 consecutive patients with AAI were included. Using the Mimics v17.0 and 3-matic v9.0 softwares, a novel drill guide template with two location holes and guide rods was designed. All patients underwent posterior atlantoaxial pedicle screw fixation assisted by the novel drill guide template. After surgery, the entry point and directions of actual and ideal screw trajectories were measured and compared. RESULTS All patients underwent surgery successfully assisted by the novel drill guide template. A total of 128 atlantoaxial pedicle screws were placed for 32 AAI patients. Postoperative CT scans showed two screws in atlas deviated medially from the pedicle cortex and entered the spinal canal about 1 mm but without symptoms. For both atlas and axis, there were no significant differences in entry point or directions between the ideal and actual screw trajectories (P > 0.05). Significant differences were found in preoperative and postoperative Japanese Orthopaedic Association score and Visual Analogue Score (P < 0.001). CONCLUSIONS It is feasible to use the novel drill guide template for atlantoaxial pedicle screw placement. The accuracy of screw placement assisted by the novel template is high. More studies are needed to confirm the efficacy of this template.
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Affiliation(s)
- Lianghai Jiang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Liang Dong
- Department of Spinal Surgery, Hong Hui Hospital, Shanxi, 710054, China
| | - Mingsheng Tan
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. .,Graduate School of Peking Union Medical College, Beijing, 100730, China.
| | - Feng Yang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Ping Yi
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiangsheng Tang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
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Deng T, Jiang M, Lei Q, Cai L, Chen L. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon) 2016; 21:143-149. [PMID: 27973960 DOI: 10.1080/24699322.2016.1236146] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ting Deng
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Minghui Jiang
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Qing Lei
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Lihong Cai
- Department of Radiology, The Third Hospital Of Changsha, Changsha, China
| | - Li Chen
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
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Rong X, Wang B, Chen H, Ding C, Deng Y, Ma L, Ma Y, Liu H. Use of rapid prototyping drill template for the expansive open door laminoplasty: A cadaveric study. Clin Neurol Neurosurg 2016; 150:13-17. [PMID: 27567386 DOI: 10.1016/j.clineuro.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/06/2016] [Accepted: 08/13/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Trough preparation is a technically demanding yet critical procedure for successful expansive open door laminoplasty (EOLP), requiring both proper position and appropriate bone removal. We aimed to use the specific rapid prototyping drill template to achieve such requirement. METHODS The 3D model of the cadaveric cervical spine was reconstructed using the Mimics 17.0 and Geomagic Studio 12.0 software. The drilling template was designed in the 3-Matic software. The trough position was simulated at the medial margin of the facet joint. Two holders were designed on both sides. On the open side, the holder would just allow the drill penetrate the ventral cortex of the lamina. On the hinge side, the holder was designed to keep the ventral cortex of the lamina intact. One orthopedic resident performed the surgery using the rapid prototyping drill template on four cadavers (template group). A control group of four cadavers were operated upon without the use of the template. RESULTS The deviation of the final trough position from the simulated trough position was 0.18mm±0.51mm in the template group. All the troughs in the template group and 40% of the troughs in the control group were at the medial side of the facet joint. The complete hinge fracture rate was 5% in the template group, significantly lower than that (55%) in the control group (P=0.01). CONCLUSION The rapid prototyping drill template could help the surgeon accomplish proper trough position and appropriate bone removal in EOLP on the cadaveric cervical spine.
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Affiliation(s)
- Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Yuxiao Deng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Lipeng Ma
- School of Power and Mechanical Engineering, Wuhan University, Wuhan, Hubei, 430072, China
| | - Yanzhao Ma
- School of Power and Mechanical Engineering, Wuhan University, Wuhan, Hubei, 430072, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
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Chen X, Xu L, Wang W, Li X, Sun Y, Politis C. Computer-aided design and manufacturing of surgical templates and their clinical applications: a review. Expert Rev Med Devices 2016; 13:853-64. [DOI: 10.1080/17434440.2016.1218758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Design and Fabrication of a Precision Template for Spine Surgery Using Selective Laser Melting (SLM). MATERIALS 2016; 9:ma9070608. [PMID: 28773730 PMCID: PMC5456883 DOI: 10.3390/ma9070608] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 11/17/2022]
Abstract
In order to meet the clinical requirements of spine surgery, this paper proposes the fabrication of the customized template for spine surgery through computer-aided design. A 3D metal printing-selective laser melting (SLM) technique was employed to directly fabricate the 316L stainless steel template, and the metal template with tiny locating holes was used as an auxiliary tool to insert spinal screws inside the patient's body. To guarantee accurate fabrication of the template for cervical vertebra operation, the contact face was placed upwards to improve the joint quality between the template and the cervical vertebra. The joint surface of the printed template had a roughness of Ra = 13 ± 2 μm. After abrasive blasting, the surface roughness was Ra = 7 ± 0.5 μm. The surgical metal template was bound with the 3D-printed Acrylonitrile Butadiene Styrene (ABS) plastic model. The micro-hardness values determined at the cross-sections of SLM-processed samples varied from HV0.3 250 to HV0.3 280, and the measured tensile strength was in the range of 450 MPa to 560 MPa, which showed that the template had requisite strength. Finally, the metal template was clinically used in the patient's surgical operation, and the screws were inserted precisely as the result of using the auxiliary template. The geometrical parameters of the template hole (e.g., diameter and wall thickness) were optimized, and measures were taken to optimize the key geometrical units (e.g., hole units) in metal 3D printing. Compared to the traditional technology of screw insertion, the use of the surgical metal template enabled the screws to be inserted more easily and accurately during spinal surgery. However, the design of the high-quality template should fully take into account the clinical demands of surgeons, as well as the advice of the designing engineers and operating technicians.
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Lu T, Liu C, Dong J, Lu M, Li H, He X. Cervical screw placement using rapid prototyping drill templates for navigation: a literature review. Int J Comput Assist Radiol Surg 2016; 11:2231-2240. [PMID: 27160327 DOI: 10.1007/s11548-016-1414-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Due to the high screw malposition rate and the potential risk of neurovascular injury in cervical fixation surgeries, guided tools, mainly computer-assisted surgery navigation systems and rapid prototyping drill templates (RPDTs) have increasingly been developed to help surgeons improve screw placement accuracy. Although RPDTs have been used in cervical surgeries for almost 2 decades, no specific review has been performed detailing the state of this technique. Thus, in the current review, we fully discuss the status of applying RPDTs in cervical surgeries. METHODS Studies that tested the accuracy and reliability of RPDTs in guiding cervical screw placements were included in this review. The fabrication workflow and usage of RPDTs, the accuracy and reliability of using RPDTs for screw and plate placement, the advantages and disadvantages of RPDTs and their prospects for future applications as a part of cervical fixation instrumentation are discussed. RESULTS As the design of RPDTs becomes more rational, the accuracy and reliability of these devices have significantly improved in cervical fixation surgeries. Moreover, RPDTs decrease the intraoperative radiation exposure for surgeons and patients relative to conventional methods. However, some disadvantages also exist. The fabrication of RPDTs is time-consuming, and the time required to learn the related software is long. CONCLUSION We believe that because of their merits, the RPDT technique is worth promoting for use in cervical surgeries. However, the time-consuming fabrication workflow and the long period required to learn the related software might limit its widespread use. In the future, the workflow should be simplified to reduce the extra workload for surgeons. Moreover, more clinical studies with high-level evidence are still needed to further test its accuracy and feasibility.
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Affiliation(s)
- Teng Lu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Chao Liu
- Department of Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Jun Dong
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Meng Lu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China.
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Mulford JS, Babazadeh S, Mackay N. Three-dimensional printing in orthopaedic surgery: review of current and future applications. ANZ J Surg 2016; 86:648-53. [PMID: 27071485 DOI: 10.1111/ans.13533] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/01/2023]
Abstract
Three-dimensional (3D) printing is a rapidly evolving technology with the potential for significant contributions to surgical practice. There are many current applications for 3D printing technology with future applications being explored. This technology has applications in preoperative planning, education, custom manufacturing (implants, prosthetics and surgical guides) and exciting potential for biological applications. This article reviews the current and future applications of 3D technology in orthopaedic surgery.
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Affiliation(s)
- Jonathan S Mulford
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Sina Babazadeh
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Neil Mackay
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
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Abstract
Three-dimensional (3-D) printing technology has rapidly developed in the last few decades. Meanwhile, the application of this technology has reached beyond the engineering field and expanded to almost all disciplines, including medicine. There has been much research on the medical applications of 3-D printing in neurosurgery, orthopedics, maxillofacial surgery, plastic surgery, tissue engineering, as well as other fields. Because of the complexity of the cardiovascular system, the application of this technology is limited and difficult, as compared to other disciplines, and thus there is much room for future development. Many of the difficulties associated with this technology must be overcome. Nonetheless, there is no doubt that 3-D printing technology will benefit patients with cardiovascular diseases in the near future.
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Affiliation(s)
- Di Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Kroes T, Valstar E, Eisemann E. Numerical optimization of alignment reproducibility for customizable surgical guides. Int J Comput Assist Radiol Surg 2015; 10:1567-78. [PMID: 25861054 PMCID: PMC4591200 DOI: 10.1007/s11548-015-1171-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 03/09/2015] [Indexed: 11/29/2022]
Abstract
Purpose Computer-assisted orthopedic surgery aims at minimizing invasiveness, postoperative pain, and morbidity with computer-assisted preoperative planning and intra-operative guidance techniques, of which camera-based navigation and patient-specific templates (PST) are the most common. PSTs are one-time templates that guide the surgeon initially in cutting slits or drilling holes. This method can be extended to reusable and customizable surgical guides (CSG), which can be adapted to the patients’ bone. Determining the right set of CSG input parameters by hand is a challenging task, given the vast amount of input parameter combinations and the complex physical interaction between the PST/CSG and the bone. Methods This paper introduces a novel algorithm to solve the problem of choosing the right set of input parameters. Our approach predicts how well a CSG instance is able to reproduce the planned alignment based on a physical simulation and uses a genetic optimization algorithm to determine optimal configurations. We validate our technique with a prototype of a pin-based CSG and nine rapid prototyped distal femora. Results The proposed optimization technique has been compared to manual optimization by experts, as well as participants with domain experience. Using the optimization technique, the alignment errors remained within practical boundaries of 1.2 mm translation and \documentclass[12pt]{minimal}
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\begin{document}$$0.9^\circ $$\end{document}0.9∘ rotation error. In all cases, the proposed method outperformed manual optimization. Conclusions Manually optimizing CSG parameters turns out to be a counterintuitive task. Even after training, subjects with and without anatomical background fail in choosing appropriate CSG configurations. Our optimization algorithm ensures that the CSG is configured correctly, and we could demonstrate that the intended alignment of the CSG is accurately reproduced on all tested bone geometries.
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Affiliation(s)
- Thomas Kroes
- Computer Graphics and Visualization Group, Department of Intelligent Systems, Delft University of Technology, Mekelweg 4, 2628 CD, Delft, The Netherlands.
| | - Edward Valstar
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.,Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Elmar Eisemann
- Computer Graphics and Visualization Group, Department of Intelligent Systems, Delft University of Technology, Mekelweg 4, 2628 CD, Delft, The Netherlands
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Takemoto M, Fujibayashi S, Ota E, Otsuki B, Kimura H, Sakamoto T, Kawai T, Futami T, Sasaki K, Matsushita T, Nakamura T, Neo M, Matsuda S. Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area. 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 2015; 25:1698-705. [PMID: 25820409 DOI: 10.1007/s00586-015-3908-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Image-based navigational patient-specific templates (PSTs) for pedicle screw (PS) placement have been described. With recent advances in three-dimensional computer-aided designs and additive manufacturing technology, various PST designs have been reported, although the template designs were not optimized. We have developed a novel PST design that reduces the contact area without sacrificing stability. It avoids susceptibility to intervening soft tissue, template geometric inaccuracy, and difficulty during template fitting. METHODS Fourteen candidate locations on the posterior aspect of the vertebra were evaluated. Among them, locations that had high reproducibility on computed tomography (CT) images and facilitated accurate PS placement were selected for the final PST design. An additive manufacturing machine (EOSINT M270) fabricated the PSTs using commercially pure titanium powder. For the clinical study, 36 scoliosis patients and 4 patients with ossification of the posterior longitudinal ligament (OPLL) were treated with thoracic PSs using our newly developed PSTs. We intraoperatively and postoperatively evaluated the accuracy of the PS hole created by the PST. RESULTS Based on the segmentation reproducibility and stability analyses, we selected seven small, round contact points for our PST: bilateral superior and inferior points on the transverse process base, bilateral inferior points on the laminar, and a superior point on the spinous process. Clinically, the success rates of PS placement using this PST design were 98.6 % (414/420) for scoliosis patients and 100 % (46/46) for OPLL patients. CONCLUSION This study provides a useful design concept for the development and introduction of patient-specific navigational templates for placing PSs.
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Affiliation(s)
- Mitsuru Takemoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Eigo Ota
- Department of Orthopaedic Surgery, Shiga Medical Center for Children, 5-7-30, Moriyama, Shiga, 524-0022, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takeshi Sakamoto
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, Osaka, 543-8555, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Tohru Futami
- Department of Orthopaedic Surgery, Shiga Medical Center for Children, 5-7-30, Moriyama, Shiga, 524-0022, Japan
| | - Kiyoyuki Sasaki
- Sagawa Printing Co. Ltd., 5-3 Morimoto-cho Inui, Mukou, Kyoto, 617-8588, Japan
| | - Tomiharu Matsushita
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi, 487-8501, Japan
| | - Takashi Nakamura
- National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, Kyoto, 612-0861, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Shuich Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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Li XS, Wu ZH, Xia H, Ma XY, Ai FZ, Zhang K, Wang JH, Mai XH, Yin QS. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study. Clinics (Sao Paulo) 2014; 69:750-7. [PMID: 25518033 PMCID: PMC4255074 DOI: 10.6061/clinics/2014(11)08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The transoral atlantoaxial reduction plate system treats irreducible atlantoaxial dislocation from transoral atlantoaxial reduction plate-I to transoral atlantoaxial reduction plate-III. However, this system has demonstrated problems associated with screw loosening, atlantoaxial fixation and concealed or manifest neurovascular injuries. This study sought to design a set of individualized templates to improve the accuracy of anterior C2 screw placement in the transoral atlantoaxial reduction plate-IV procedure. METHODS A set of individualized templates was designed according to thin-slice computed tomography data obtained from 10 human cadavers. The templates contained cubic modules and drill guides to facilitate transoral atlantoaxial reduction plate positioning and anterior C2 screw placement. We performed 2 stages of cadaveric experiments with 2 cadavers in stage one and 8 in stage two. Finally, guided C2 screw placement was evaluated by reading postoperative computed tomography images and comparing the planned and inserted screw trajectories. RESULTS There were two cortical breaching screws in stage one and three in stage two, but only the cortical breaching screws in stage one were ranked critical. In stage two, the planned entry points and the transverse angles of the anterior C2 screws could be simulated, whereas the declination angles could not be simulated due to intraoperative blockage of the drill bit and screwdriver by the upper teeth. CONCLUSIONS It was feasible to use individualized templates to guide transoral C2 screw placement. Thus, these drill templates combined with transoral atlantoaxial reduction plate-IV, may improve the accuracy of transoral C2 screw placement and reduce related neurovascular complications.
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Affiliation(s)
- Xue-Shi Li
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
- Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Zeng-Hui Wu
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Hong Xia
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Xiang-Yang Ma
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Fu-Zhi Ai
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Kai Zhang
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Jian-Hua Wang
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Xiao-Hong Mai
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
| | - Qing-Shui Yin
- Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), Institute of Traumatic Orthopaedics of People's Liberation Army, Key Laboratory of Orthopaedic Tecnology and Implant Materials of Guangdong Province, Department of Orthopedics, Guangzhou, 510010, People's Republic of China
- *co-corresponding authors
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Hu Y, Yuan ZS, Kepler CK, Albert TJ, Xie H, Yuan JB, Dong WX, Wang CT. Deviation analysis of atlantoaxial pedicle screws assisted by a drill template. Orthopedics 2014; 37:e420-7. [PMID: 24810817 DOI: 10.3928/01477447-20140430-51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
Although C1-C2 pedicle screw fixation provides an excellent fusion rate and rigid fixation, this technique has a potential risk. It is essential to develop an accurate screwing method to avoid this neurovascular injury. To develop and validate the accuracy of a novel navigational template for C1-C2 pedicle screw placement in cadaveric specimens, computed tomography scans with 1-mm-wide cuts were obtained of 32 cadaveric cervical specimens. The authors developed 64 three-dimensional full-scale templates that were created by computer modeling with a rapid prototyping technique from the computed tomography data. Drill templates were constructed with a custom trajectory for each level and side. The drill templates were used to guide the establishment of a pilot hole for screw placement. The average distances between ideal and actual entry points of the C1 pedicle screws in the x, y, and z axes were 0.16±0.46 mm, 0.11±0.52 mm, and -0.01±0.54 mm, respectively, on the left side and 0.11±0.49 mm, 0.01±0.56 mm, and -0.09±0.59 mm, respectively, on the right side. The average distances between ideal and actual entry points of the C2 pedicle screws in the x, y, and z axes were 0.05±0.54 mm, 0.20±0.59 mm, and -0.06±0.58 mm, respectively, on the left side and 0.17±0.55 mm, 0.1±0.58 mm, and -0.01±0.49 mm, respectively, on the right side. Factors related to human error and imprecision are responsible for most malpositioning of instrumentation. The rapid prototyping drill template for C1-C2 screw placement is described to minimize human error, although it introduces error related to computer software and variation in manufacturing.
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Victor J, Premanathan A. Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Joint J 2014; 95-B:153-8. [PMID: 24187376 DOI: 10.1302/0301-620x.95b11.32950] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have investigated the benefits of patient specific instrument guides, applied to osteotomies around the knee. Single, dual and triple planar osteotomies were performed on tibias or femurs in 14 subjects. In all patients, a detailed pre-operative plan was prepared based upon full leg standing radiographic and CT scan information. The planned level of the osteotomy and open wedge resection was relayed to the surgery by virtue of a patient specific guide developed from the images. The mean deviation between the planned wedge angle and the executed wedge angle was 0° (-1 to 1, sd 0.71) in the coronal plane and 0.3° (-0.9 to 3, sd 1.14) in the sagittal plane. The mean deviation between the planned hip, knee, ankle angle (HKA) on full leg standing radiograph and the post-operative HKA was 0.3° (-1 to 2, sd 0.75). It is concluded that this is a feasible and valuable concept from the standpoint of pre-operative software based planning, surgical application and geometrical accuracy of outcome.
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Affiliation(s)
- J Victor
- Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Schweizer A, Fürnstahl P, Nagy L. Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg Am 2013; 38:2339-47. [PMID: 24189159 DOI: 10.1016/j.jhsa.2013.09.023] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions. METHODS Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data. RESULTS In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes. CONCLUSIONS Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andreas Schweizer
- Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland.
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Hu Y, Yuan ZS, Spiker WR, Albert TJ, Dong WX, Xie H, Yuan JB, Wang CT. Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template: a cadaveric study. 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 2013; 22:2770-6. [PMID: 24005997 DOI: 10.1007/s00586-013-2993-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/30/2013] [Accepted: 08/29/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The goal of this study is to evaluate the accuracy of patient-specific CT-based rapid prototype drill templates for C2 translaminar screw insertion. METHODS Volumetric CT scanning was performed in 32 cadaveric cervical spines. Using computer software, the authors constructed drill templates that fit onto the posterior surface of the C2 vertebrae with drill guides to match the slope of the patient's lamina. Thirty-two physical templates were created from the computer models using a rapid prototyping machine. The drill templates were used to guide drilling of the lamina and post-operative CT images were obtained. The entry point and direction of the planned and inserted screws were measured and compared. RESULTS Sixty-four C2 translaminar screws were placed without violating the cortical bone of a single lamina. The bilateral average transverse angle of intended and actual screw for C2TLS was 56.60 ± 2.22°, 56.38 ± 2.51°, 56.65 ± 2.24°, 56.39 ± 2.45°. The bilateral mean coronal angle of the planned and actual screw for C2TLS was 0°, 0°, -0.07 ± 0.32°, 0.12 ± 0.57°. The average displacement of the entry point of the superior and inferior C2TLS in the x, y, z axis was 0.27 ± 0.85, 0.49 ± 1.46, -0.28 ± 0.69, 0.43 ± 0.88, 0.38 ± 1.51, 0.23 ± 0.64 mm. CONCLUSION The small deviations seen are likely due to human error in the form of small variations in the surgical technique and use of software to design the prototype. This technology improves the safety profile of this fixation technique and should be further studied in clinical applications.
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Affiliation(s)
- Yong Hu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, Zhejiang, China,
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Merc M, Drstvensek I, Vogrin M, Brajlih T, Recnik G. A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine. Arch Orthop Trauma Surg 2013; 133:893-9. [PMID: 23632782 DOI: 10.1007/s00402-013-1755-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. MATERIALS AND METHODS In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups. RESULTS The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group. CONCLUSIONS The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.
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Affiliation(s)
- Matjaz Merc
- Department of Orthopaedic Surgery, UKC Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
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Chai W, Xu M, Zhang GQ, Zhang LH, Gou WL, Ni M, Chen JY. Computer-aided design and custom-made guide in corrective osteotomy for complex femoral deformity. ACTA ACUST UNITED AC 2013; 33:398-405. [PMID: 23771667 DOI: 10.1007/s11596-013-1131-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Indexed: 11/28/2022]
Abstract
Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral deformities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography (CT) scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional (3D) photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were designed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the operation as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpretation three-dimensional visualization introduces an advantage in preoperative planning for corrective osteotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a deliberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.
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Affiliation(s)
- Wei Chai
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Xu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Qiang Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li-Hai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wen-Long Gou
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ming Ni
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ji-Ying Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
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Van den Broeck J, Wirix-Speetjens R, Vander Sloten J. Preoperative analysis of the stability of fit of a patient-specific surgical guide. Comput Methods Biomech Biomed Engin 2013; 18:38-47. [PMID: 23627973 DOI: 10.1080/10255842.2013.774383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although the use of patient-specific surgical guides has gained popularity over the past decade, little research has been done to examine in an objective and qualitative way the fit of such instruments. In this study, we have developed a model to predict the stability of a guide designed to fit on a supporting bone surface, thereby providing feedback on the translational and rotational stability of the device. The method was validated by comparing different guide designs with respect to their stability on the contact surface and comparing these results to those measured with a set of experiments. This validation experiment indicates that our stability model can be used to predict the stability of the fit of a surgical guide during the preoperative design process.
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Affiliation(s)
- Joyce Van den Broeck
- a Department of Mechanical Engineering , KU Leuven, Celestijnenlaan 300C, Heverlee 3001 , Belgium
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Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template. Med Biol Eng Comput 2012; 50:751-8. [PMID: 22467276 DOI: 10.1007/s11517-012-0900-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/17/2012] [Indexed: 12/20/2022]
Abstract
With the rapid increase in the use of thoracic pedicle screws in scoliosis, accurate and safe placement of screw within the pedicle is a crucial step during the scoliosis surgery. To make thoracic pedicle screw placement safer various techniques are used, Patient-specific drill template with pre-planned trajectory has been thought as a promising solution, it is critical to assess the efficacy, safety profile with this technique. In this paper, we develop and validate the accuracy and safety of thoracic transpedicular screw placement with patient-specific drill template technique in scoliosis. Patients with scoliosis requiring instrumentation were recruited. Volumetric CT scan was performed on each desired thoracic vertebra and a 3-D reconstruction model was generated from the CT scan data. The optimal screw size and orientation were determined and a drill template was designed with a surface that is the inverse of the posterior vertebral surface. The drill template and its corresponding vertebra were manufactured using rapid prototyping technique and tested for violations. The navigational template was sterilized and used intraoperatively to assist with the placement of thoracic screws. After surgery, the positions of the pedicle screws were evaluated using CT scan and graded for validation. This method showed its ability to customize the placement and the size of each pedicle screw based on the unique morphology of the thoracic vertebra. In all the cases, it was relatively very easy to manually place the drill template on the lamina of the vertebral body during the surgery. This method significantly reduces the operation time and radiation exposure for the members of the surgical team, making it a practical, simple and safe method. The potential use of such a navigational template to insert thoracic pedicle screws in scoliosis is promising. The use of surgical navigation system successfully reduced the perforation rate and insertion angle errors, demonstrating the clear advantage in safe and accurate pedicle screw placement of scoliosis surgery.
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Lu S, Xu YQ, Chen GP, Zhang YZ, Lu D, Chen YB, Shi JH, Xu XM. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. ACTA ACUST UNITED AC 2011; 16:240-8. [PMID: 21838535 DOI: 10.3109/10929088.2011.605173] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To develop and validate the efficacy and accuracy of a novel drill template for cervical pedicle instrumentation. MATERIALS AND METHODS A CT scan of the cervical vertebrae was performed, and a 3D model of the vertebrae was reconstructed using MIMICS 10.01 software. The 3D vertebral model was then exported in STL format, and opened in a workstation running UGS Imageware 12.0 software to determine the optimal pedicle screw size and orientation. A virtual navigational template was established according to the laminar anatomic trait, and physical navigational templates were manufactured using rapid prototyping. The navigational templates were used intraoperatively to assist in the placement of cervical pedicle screws. RESULTS In all, 84 pedicle screws were placed, and the accuracy of screw placement was confirmed with postoperative X-rays and CT scans. Eighty-two screws were rated as Grade 0, 2 as Grade 1, and no screws as Grade 2 or 3. Hence, safer screw positioning was accomplished with the drill template technique. CONCLUSIONS This study demonstrates a patient-specific template technique that is easy to use, can simplify the surgical act, and generates highly accurate cervical pedicle screw placement. The advantages of this technology over traditional techniques are that it enables planning of the screw trajectory to be completed prior to surgery, and that the screw can be sized to fit the patient's anatomy.
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Affiliation(s)
- Sheng Lu
- Department of Orthopedics, Kunming General Hospital, China
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