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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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A Comparison of Drill Guiding and Screw Guiding 3D-Printing Techniques for Intra- and Extrapedicular Screw Insertion. Spine (Phila Pa 1976) 2022; 47:E434-E441. [PMID: 34132234 DOI: 10.1097/brs.0000000000004147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Screw randomized cadaveric study. OBJECTIVE To compare the accuracy of three-dimensional (3D)-printed drill guides versus additional screw guiding techniques for challenging intra- and extrapedicular screw trajectories. SUMMARY OF BACKGROUND DATA Pedicle screw placement can be technically demanding, especially in syndromic scoliosis with limited bone stock. Recently, 3D-printing and virtual planning technology have become available as new tools to improve pedicle screw insertion. Differences in techniques exist, while some focus on guiding the drill, others also actively guide subsequent screws insertion. The accuracy of various 3D-printing-assisted techniques has been studied; however, direct comparative studies have yet to determine whether there is a benefit of additional screw guidance. METHODS Two cadaveric experiments were conducted to compare drill guides with two techniques that introduce additional screw guiding. The screw guiding consisted of either k-wire cannulated screws or modular guides, which were designed to guide the screw in addition to the drill bit. Screws were inserted intra- or extrapedicular using one of each methods according to a randomization scheme. Postoperative computed tomography scanning was performed and fused with the preoperative planning for detailed 3D screw deviation analysis. RESULTS For intrapedicular screw trajectories malpositioning was low (2%) and the modular guides revealed a statistically significant increase of accuracy (P = 0.05) compared with drill guides. All techniques showed accurate cervical screw insertion without breach. For the extrapedicular screw trajectories both additional screw guiding methods did not significantly (P = 0.09) improve accuracy and malpositioning rates remained high (24%). CONCLUSIONS In this cadaveric study it was found that the additional screw-guiding techniques are not superior to the regular 3D-printed drill guides for the technically demanding extrapedicular screw technique. For intrapedicular screw insertion, modular guides can improve insertion; however, at cervical levels regular 3D-printed drill guides already demonstrated very high accuracy and therefore there is no benefit from additional screw guiding techniques. LEVEL OF EVIDENCE 3.
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Ashouri-Sanjani M, Mohammadi-Moghadam S, Azimi P, Arjmand N. Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines. HSS J 2021; 17:213-222. [PMID: 34421433 PMCID: PMC8361592 DOI: 10.1177/1556331621996331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/11/2020] [Indexed: 01/26/2023]
Abstract
Background: Pedicle screw (PS) placement has been widely used in fusion surgeries on the thoracic spine. Achieving cost-effective yet accurate placements through nonradiation techniques remains challenging. Questions/Purposes: Novel noncovering lock-mechanism bilateral vertebra-specific drill guides for PS placement were designed/fabricated, and their accuracy for both nondeformed and deformed thoracic spines was tested. Methods: One nondeformed and 1 severe scoliosis human thoracic spine underwent computed tomographic (CT) scanning, and 2 identical proportions of each were 3-dimensional (3D) printed. Pedicle-specific optimal (no perforation) drilling trajectories were determined on the CT images based on the entry point/orientation/diameter/length of each PS. Vertebra-specific templates were designed and 3D printed, assuring minimal yet firm contacts with the vertebrae through a noncovering lock mechanism. One model of each patient was drilled using the freehand and one using the template guides (96 pedicle drillings). Postoperative CT scans from the models with the inserted PSs were obtained and superimposed on the preoperative planned models to evaluate deviations of the PSs. Results: All templates fitted their corresponding vertebra during the simulated operations. As compared with the freehand approach, PS placement deviations from their preplanned positions were significantly reduced: for the nonscoliosis model, from 2.4 to 0.9 mm for the entry point, 5.0° to 3.3° for the transverse plane angle, 7.1° to 2.2° for the sagittal plane angle, and 8.5° to 4.1° for the 3D angle, improving the success rate from 71.7% to 93.5%. Conclusions: These guides are valuable, as the accurate PS trajectory could be customized preoperatively to match the patients' unique anatomy. In vivo studies will be required to validate this approach.
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Affiliation(s)
| | | | - Parisa Azimi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran,Navid Arjmand, PhD, Department of Mechanical Engineering, Sharif University of Technology, Tehran 11155-9567, Iran.
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Kanawati A, Fernandes RJR, Gee A, Urquhart J, Siddiqi F, Gurr K, Bailey C, Rasoulinejad P. Geometric and Volumetric Relationship Between Human Lumbar Vertebra and CT-based Models. Acad Radiol 2021; 28:e172-e181. [PMID: 32620526 DOI: 10.1016/j.acra.2020.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 01/17/2023]
Abstract
RATIONALE AND OBJECTIVES Crucial to the process of three-dimensional (3D) printing is the knowledge of how the actual structure or organ relates dimensionally to its corresponding medical image. This study will examine the differences between human lumbar vertebrae, 3D scans of these bones, 3D models based on computed tomographic (CT) scans, and 3D-printed models. MATERIALS AND METHODS CT scans were obtained for six human lumbar spines. The bones were cleaned, and 3D scanned. 3D mesh models were created from the CT data, and then 3D printed. Four models were analyzed: anatomic bones, 3D-scanned models, CT-models, and 3D-printed models. Manual measurements were performed for all model types, and segmentation metric comparisons were performed comparing the 3D-scanned models to the CT-models. RESULTS There was no statistical difference between manual measurements when comparing each parameter of all model types, except for vertebral width (p = 0.044). There was no statistical difference when comparing the average of all measurements between all model types (p = 0.247). The mean Hausdorff distance was 0.99 mm (SD 0.55 mm) when comparing 3D-scanned model to CT-model. The mean Dice coefficient was 0.90 (SD 0.07) when comparing 3D-scanned model to CT-model. The mean volume for 3D-scanned model and CT-model were 41.6 ml and 45.9 ml (p < 0.001), respectively. CONCLUSION This study clarifies the geometric and volumetric relationship between human lumbar vertebra and CT-based vertebral models. Segmentation metrics reveal a 1 mm difference between examined bones (using the 3D-scanned bone as a surrogate), and the CT measurements. This is confirmed by a volumetric difference of 4.3 ml, between the larger CT-based model and the smaller bone.
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Affiliation(s)
- Andrew Kanawati
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada; Westmead Hospital, Sydney, NSW, Australia.
| | | | - Aaron Gee
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
| | - Jennifer Urquhart
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
| | - Fawaz Siddiqi
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
| | - Kevin Gurr
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
| | - Chris Bailey
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
| | - Parham Rasoulinejad
- London Health Science Centre, Victoria Hospital, 800 Commissioners Rd E, E1-305, London, ON N6A 5W9, Canada
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Kanawati A, Rodrigues Fernandes RJ, Gee A, Urquhart J, Siddiqi F, Gurr K, Bailey CS, Rasoulinejad P. The Development of Novel 2-in-1 Patient-Specific, 3D-Printed Laminectomy Guides with Integrated Pedicle Screw Drill Guides. World Neurosurg 2021; 149:e821-e827. [PMID: 33540103 DOI: 10.1016/j.wneu.2021.01.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if 2-in-1 patient-specific laminectomy and drill guides can be safely used to perform laminectomy and pedicle screw insertion. METHODS This was a cadaveric study designed to test novel 2-in-1 patient-specific laminectomy guides, with modular removable pedicle screw drill guides. Three-dimensional (3D) printing has not been applied to laminectomy. This cadaveric study tests novel 2-in-1 patient-specific laminectomy guides, with modular removable pedicle screw drill guides. Computed tomography (CT) scans of 3 lumbar spines were imported into 3D Slicer. Spinal models and patient-specific guides were created and 3D printed. The bones were cleaned to visualize and record the under surface of the lamina during laminectomy. Pedicle screws and laminectomies were performed with the aid of patient-specific guides. CT scans were performed to compare planned and actual screw and laminectomy positions. RESULTS Thirty screws were inserted in 15 lumbar vertebrae by using the integrated 2-in-1 patient-specific drill guides. There were no cortical breaches on direct examination, or on postoperative CT. Digital video analysis revealed the burr tip did not pass deep to the inner table margin of the lamina in any of the 30 laminectomy cuts. Average surgical time was 4 minutes and 46 seconds (standard deviation, 1 min 38 sec). CONCLUSIONS This study has explored the development of novel 2-in-1 patient-specific, 3D-printed laminectomy guides with integrated pedicle screw drill guides, which are accurate and safe in the laboratory setting. These instruments have the potential to simplify complex surgical steps, and improve accuracy, time, and cost.
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Affiliation(s)
- Andrew Kanawati
- London Health Science Centre, Victoria Hospital-London, Ontario, Canada; Westmead Hospital, Sydney, NSW, Australia.
| | | | - Aaron Gee
- London Health Science Centre, Victoria Hospital-London, Ontario, Canada
| | - Jennifer Urquhart
- London Health Science Centre, Victoria Hospital-London, Ontario, Canada
| | - Fawaz Siddiqi
- London Health Science Centre, Victoria Hospital-London, Ontario, Canada
| | - Kevin Gurr
- London Health Science Centre, Victoria Hospital-London, Ontario, Canada
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Pijpker PA, Kraeima J, Witjes MJ, Oterdoom DM, Vergeer RA, Coppes MH, Groen RJ, Kuijlen JM. Accuracy of Patient-Specific 3D-Printed Drill Guides for Pedicle and Lateral Mass Screw Insertion: An Analysis of 76 Cervical and Thoracic Screw Trajectories. Spine (Phila Pa 1976) 2021; 46:160-168. [PMID: 33093310 PMCID: PMC7787187 DOI: 10.1097/brs.0000000000003747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single-center retrospective case series. OBJECTIVE The purpose of this study was to assess the safety and accuracy of three-dimensional (3D)-printed individualized drill guides for pedicle and lateral mass screw insertion in the cervical and upper-thoracic region, by comparing the preoperative 3D surgical plan with the postoperative results. SUMMARY OF BACKGROUND DATA Posterior spinal fusion surgery can provide rigid intervertebral fixation but screw misplacement involves a high risk of neurovascular injury. However, modern spine surgeons now have tools such as virtual surgical planning and 3D-printed drill guides to facilitate spinal screw insertion. METHODS A total of 15 patients who underwent posterior spinal fusion surgery involving patient-specific 3D-printed drill guides were included in this study. After segmentation of bone and screws, the postoperative models were superimposed onto the preoperative surgical plan. The accuracy of the realized screw trajectories was quantified by measuring the entry point and angular deviation. RESULTS The 3D deviation analysis showed that the entry point and angular deviation over all 76 screw trajectories were 1.40 ± 0.81 mm and 6.70 ± 3.77°, respectively. Angular deviation was significantly higher in the sagittal plane than in the axial plane (P = 0.02). All screw positions were classified as "safe" (100%), showing no neurovascular injury, facet joint violation, or violation of the pedicle wall. CONCLUSIONS 3D virtual planning and 3D-printed patient-specific drill guides appear to be safe and accurate for pedicle and lateral mass screw insertion in the cervical and upper-thoracic spine. The quantitative 3D deviation analyses confirmed that screw positions were accurate with respect to the 3D-surgical plan.Level of Evidence: 4.
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Affiliation(s)
- Peter A.J. Pijpker
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Joep Kraeima
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
| | - Max J.H. Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
| | - D.L. Marinus Oterdoom
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Rob A. Vergeer
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Maarten H. Coppes
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Rob J.M. Groen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Jos M.A. Kuijlen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
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Wang L, Zhao L, Gu Y, Yu L, Ma W, Xu R. Effectiveness of 2 Types of Drill Templates for Cervical Anterior Transpedicular Screw Placements: A Comparative Study. World Neurosurg 2020; 147:e343-e350. [PMID: 33346054 DOI: 10.1016/j.wneu.2020.12.055] [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: 08/04/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate effectiveness of regular and modified drill templates used to guide cervical anterior transpedicular screw (ATPS) placement. METHODS This study included 15 adult cadaveric specimens. Computed tomography images were imported into Mimics software. Three-dimensional modeling of all cervical vertebrae was done, and the ideal trajectories were designed for ATPSs. Models of regular and modified templates were designed for every level on the left or right side randomly. After three-dimensional printing, 2 types of templates were used to guide the insertion. Postoperative computed tomography scans were used to measure deviations between real and ideal trajectories in the direction and positioning of entry points. The deviations in the 2 groups were compared using paired t test. RESULTS There were 120 templates and ATPSs fabricated and placed. Postoperative images showed that 7 screws perforated pedicles in the regular group, with an accuracy rate of 88.3%. Deviations between real and ideal trajectories in cranially inclined angles and extroversive angles were 1.13° ± 0.61° and 0.97° ± 0.60°, respectively, and deviations of entry point position in the x-axis and y-axis were 0.72 ± 0.38 mm and 0.95 ± 0.47 mm, respectively. In the modified group, there were 2 malposition screws with accuracy rate of 96.7%. Deviations in cranially inclined angles were 0.66° ± 0.53° and 0.66° ± 0.55° in extroversive angles, respectively, and deviations in entry point positions in the x-axis and y-axis were 0.45 ± 0.37 mm and 0.51 ± 0.34 mm, respectively. The differences in deviations between groups were statistically significant. CONCLUSIONS Compared with regular drill templates, modified drill templates can provide higher accuracy and stronger trajectory control in ATPS insertions.
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Affiliation(s)
- Liran Wang
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Liujun Zhao
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China.
| | - Yongjie Gu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Liang Yu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Rongming Xu
- Department of Orthopedics, Mingzhou Hospital of Zhejiang University, Ningbo, China
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“In Vivo” Validation of 3D-Printed Innovative Surgical Template for Lumbar Spinal Arthrodesis. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10175977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The most common type of spine instrumentation is the pedicle screw fixation. The recent literature shows how customized drilling templates help surgeons to perform the surgery better. This work aims to validate the design of a customized template for inserting lumbar pedicle screw via a procedure based on rapid prototyping and reverse engineering techniques and to show the benefits. The novelties of this template are its low-invasive sizes, its design based on a patented algorithm, which calculates the sizes of the screws and the optimal insertion direction, the engage/disengage system, and the adaptability to every kind of surgeon’s kit. Accuracy of pedicle screw location, surgery duration, and X-ray exposition have been used to evaluate the performances of the template. Mono-centric in vivo trial was performed. Twenty patients (8 women and 12 men) were enrolled randomly corresponding to sixty vertebrae treated with spinal arthrodesis (30 with and 30 without templates). Accuracy of the screw positioning and reduction in both surgery duration and patients’ exposure to X-rays achieved excellent results because the time spent on the insertion of pedicle screws via the surgical template was cut down by about 63%, while the number of X-ray shots was reduced by about 92%. The proposed template performed better than the standard approach and could be helpful both for skilled and novice surgeons.
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Zhong H, Chen J, Zhang C, Li Z, Lu S. [Clinical application of vertebral arch-transverse pathway in pedicle screw implantation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1486-1490. [PMID: 31823545 DOI: 10.7507/1002-1892.201810124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial. Methods Twenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation. Results The time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021]. Conclusion Compared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.
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Affiliation(s)
- Hui Zhong
- Department of Spine Surgery, the 926 Hospital of Joint Logistics Support Force of Chinese PLA, Kaiyuan Yunnan, 661600, P.R.China
| | - Jianming Chen
- Department of Spine Surgery, the 926 Hospital of Joint Logistics Support Force of Chinese PLA, Kaiyuan Yunnan, 661600, P.R.China
| | - Chengcheng Zhang
- Department of Spine Surgery, the 926 Hospital of Joint Logistics Support Force of Chinese PLA, Kaiyuan Yunnan, 661600, P.R.China
| | - Zhanqing Li
- Department of Spine Surgery, the 926 Hospital of Joint Logistics Support Force of Chinese PLA, Kaiyuan Yunnan, 661600, P.R.China
| | - Sheng Lu
- Department of Orthopedics, the First People's Hospital of Yunnan Province, Kunming Yunnan, 650032,
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10
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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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Prospective Multicenter Study of a Multistep Screw Insertion Technique Using Patient-Specific Screw Guide Templates for the Cervical and Thoracic Spine. Spine (Phila Pa 1976) 2018; 43:1685-1694. [PMID: 30045345 DOI: 10.1097/brs.0000000000002810] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective clinical study of a multistep screw insertion method using a patient-specific screw guide template system (SGTS) for the cervical and thoracic spine. OBJECTIVE To evaluate the efficacy of SGTS for inserting screws into the cervical and thoracic spine. SUMMARY OF BACKGROUND DATA Posterior screw fixation is a standard procedure for spinal instrumentation; however, screw insertion carries the risk of injury to neuronal and vascular structures. METHODS Preoperative bone images of the computed tomography (CT) scans were analyzed using 3D/multiplanar imaging software, and the screw trajectories were planned. Plastic templates with screw-guiding structures were created for each lamina using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all the templates were specially designed to fit and lock onto the lamina during the procedure. In addition, plastic vertebra models were generated, and preoperative screw insertion simulation was performed. This patient-specific SGTS was used to perform the surgery, and CT scanning was used to postoperatively evaluate screw placement. RESULTS Enrolled to verify this procedure were 103 patients with cervical, thoracic, or cervicothoracic pathologies. The SGTS were used to place 813 screws. Preoperatively, each template was found to fit exactly and to lock onto the lamina of the vertebra models. In addition, intraoperatively, the templates fit and locked onto the patient lamina, and the screws were inserted successfully. Postoperative CT scans confirmed that 801 screws (98.5%) were accurately placed without cortical violation. There were no injuries to the vessels or nerves. CONCLUSION The multistep, patient-specific SGTS is useful for intraoperative pedicle screw (PS) navigation in the cervical and thoracic spine. This method improves the accuracy of PS insertion and reduces the operating time and radiation exposure during spinal fixation surgery. LEVEL OF EVIDENCE 3.
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Computer-assisted Patient-specific Prototype Template for Thoracolumbar Cortical Bone Trajectory Screw Placement: A Cadaveric Study. Tech Orthop 2017; 33:246-250. [PMID: 30542224 PMCID: PMC6250272 DOI: 10.1097/bto.0000000000000285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cortical bone trajectory (CBT) screw technique yields effective mechanical and clinical results, improving the holding screw strength with a less invasive exposure. Accurate and safe screw placement is crucial. A patient-specific drill template with a preplanned trajectory was considered a promising solution; however, it is critical to assess the efficacy and safety of this technique. This study aims to evaluate the accuracy of patient-specific computed tomography (CT)-based rapid prototype drill guide templates for the CBT technique. CT scanning was performed in 7 cadaveric thoracolumbar spines, and a 3-dimensional reconstruction model was generated. By using computer software, we constructed drill templates that fit onto the posterior surface of thoracolumbar vertebrae with drill guides to match the CBT. In total, 80 guide templates from T11 to L5 were created from the computer models by using rapid prototyping. The drill templates were used to guide the drilling of CBT screws without any fluoroscopic control, and CT images were obtained after fixation. The entry point and direction of the planned and inserted screws were measured and compared. In total, 80 screws were inserted from T11 to L5. No misplacement or bony perforation was observed on postoperative CT scan. The patient-specific prototype template system showed the advantage of safe and accurate cortical screw placement in the thoracolumbar spine. This method showed its ability to customize the patient-specific trajectory of the spine, based on the unique morphology of the spine. The potential use of drill templates to place CBT screws is promising.
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