1
|
Dimensional accuracy of 3D printing navigation templates of chemical-based sterilisation. Sci Rep 2022; 12:1253. [PMID: 35075238 PMCID: PMC8786919 DOI: 10.1038/s41598-022-05412-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
3D printed navigational templates have facilitated the accurate treatment of orthopaedic patients. However, during practical operation, it is found that the location hole occasionally deviates from the ideal channel. As such, there will be a security risk in clinical applications. The purpose of this study was to evaluate the influence of chemical-based sterilisation methods on the dimensional accuracy of different materials and the influence of module parameters on the degree of deformation. We found that polylactic (PLA) modules sterilised with ethylene oxide (EO) would undergo micro-deformation, and these micro-deformation characteristics depend on the building direction, i.e., the module stretches in the Z direction and shrinks in the X and Y directions. Heat-resisting polylactide (HR-PLA) has the same melting temperature (Tm) as PLA, but its glass transition temperature (Tg) is greater than the EO sterilisation temperature, so there is no obvious deformation after EO sterilisation. The layer height of the module were inversely proportional to the degree of deformation in the same sterilisation method. The deformation time of the module is concentrated within 2 h after heating. The micro-deformation of the 3D printing module depends on its Tg, sterilisation temperature, and duration of the sterilisation cycle.
Collapse
|
2
|
Chen YY, Chao LC, Fang JJ, Lee EJ. 3D-Customized Guiding Template for Posterior Fixation in Complex Atlantoaxial Instability-Preliminary Experiences of National Cheng Kung University Hospital. J Neurol Surg Rep 2020; 81:e20-e27. [PMID: 32257765 PMCID: PMC7108954 DOI: 10.1055/s-0039-1695795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/18/2019] [Indexed: 11/02/2022] Open
Abstract
Objective Atlantoaxial fixation is technically demanding and challenging, especially in cases with anatomical abnormality. The purpose of this study is to report the effectiveness of the three-dimensional (3D)-customized guiding template for placement of C1 and C2 screws in cases with abnormalities. Method Two patients with anatomical abnormality and one without were included. The preoperative computed tomography (CT) image was analyzed using our software. The entry point, trajectory, and depth of the screws were designed based on these images. Templates with screw guiding cylinders and cervical spine model were created. In operation, guiding templates were applied directly to the laminae. Drilling, tapping, and screwing were performed through the cylinders. To evaluate the accuracy, deviation of the screw axis from the preplanned trajectory was measured on postoperative CT. A classification system was taking to evaluate the pedicle screw insertion. Results In complex cases, one of C2 screws has grade 2 deviation, and two has grade 1. There was no deviation in screws of C1. All patients achieved symptoms free after 6 months follow-up. Conclusion Although 3D-printed template for atlantoaxial fixation still has limitation in complex cases, it has been proved usefulness and makes the most difficult and dangerous spinal posterior fixation easy to achieve.
Collapse
Affiliation(s)
- Yi-Yun Chen
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
| | - Liang-Chun Chao
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
| | - Jing-Jing Fang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - E-Jian Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
| |
Collapse
|
3
|
Hara T, Iwamuro H, Ohara Y, Matsuoka H, Kikuchi N, Kimura T, Arai H, Mizuno J. Efficacy of Atlantoaxial Transarticular Screw Fixation Using Navigation-Guided Drill: Technical Note. World Neurosurg 2019; 134:378-382. [PMID: 31698122 DOI: 10.1016/j.wneu.2019.10.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atlantoaxial transarticular screw fixation (TASF) is a procedure that involves inserting screws vertically into the articular processes of C1 and C2. However, this procedure is associated with a risk of injury to surrounding structures including the vertebral artery, carotid artery, pharynx, and spinal cord by misinserting K-wires or screws. This study was performed to evaluate the risk of TASF using 3-dimensional navigation-guided drilling and screw insertion tract creation. METHODS Three patients underwent the surgical procedure using a navigation system guided by intraoperative computed tomography. The insertion tract of the screw was created using the navigation system to avoid penetration of the C1 anterior arch or damage to the vertebral artery. A blunt-tipped guide wire was used, which was safe to advance to the cortex of the anterior arch of C1. RESULTS There were no complications or instrument failures in any of the surgeries. In each case, the total radiation dose delivered was 5.31-7.02 mGy, and total radiation exposure time was 55.6-106.8 seconds. Bone fusion was achieved in all cases. CONCLUSIONS TASF using a navigation system for drilling is useful for accurate placement of K-wire and preventing damage of the vital structures, lowering the risk of the procedure.
Collapse
Affiliation(s)
- Takeshi Hara
- Department of Neurosurgery, Juntendo University, Tokyo, Japan.
| | | | - Yukoh Ohara
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | | | | | | | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | | |
Collapse
|
4
|
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]
|
5
|
Wu HH, Su IC, Hsieh CT, Fang JJ, Chang CJ. Accuracy and Safety of Using Customized Guiding Templates for Cervical Pedicle Screw Insertion in Severe Cervical Deformity, Fracture, and Subluxation: A Retrospective Study of 9 Cases. World Neurosurg 2018; 116:e1144-e1152. [PMID: 29870845 DOI: 10.1016/j.wneu.2018.05.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Hsin Hung Wu
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan
| | - I-Chang Su
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Cheng-Ta Hsieh
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jing-Jing Fang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Ju Chang
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Mechanical Engineering, National Central University, Taoyuan County, Taiwan.
| |
Collapse
|
6
|
Percutaneous Posterior Transarticular Atlantoaxial Fixation for the Treatment of Odontoid Fractures in the Elderly: A Prospective Study. Spine (Phila Pa 1976) 2018; 43:761-766. [PMID: 28922277 DOI: 10.1097/brs.0000000000002417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study of 20 multimorbid patients older than 65 years undergoing minimally invasive surgical treatment for odontoid fracture. OBJECTIVE To analyze the results of percutaneous transarticular atlantoaxial screw fixation as a new minimally invasive treatment modality in this high risk group of patients. SUMMARY OF BACKGROUND DATA Odontoid fractures are a common injury pattern in the elderly. These fractures typically present significant challenges as geriatric patients often have multiple comorbidities that may adversely affect fracture management. Despite numerous publications on this subject, with a trend toward primary operative stabilization, the appropriate treatment for this frequent and potentially life threatening injury remains controversial. METHODS Between January 2013 and December 2015, 20 consecutive patients underwent posterior percutaneous transarticular atlantoaxial screw fixation for odontoid fracture type II. The two main inclusion criteria were age 65 years or older and ASA score of III or IV. The screws were inserted percutaneously with the help of two fluoroscopy devices. Clinical and radiological examinations were regularly performed for a minimum of 18 months postoperatively. RESULTS The mean age was 81 years, all of them with multiple comorbidities. Reduction of the fracture and screw insertion was possible in all cases. The mean operative time was 51.75 minutes and mean blood loss was 41.7 mL. Three patients died in the first 3 months after surgery. Healing of the fracture occurred in 15 patients (88.2%). Revision surgery was not necessary in any of the patients. Mean visual analogue scale (VAS) at the final follow-up was 2.4, and mean patient satisfaction score was 7.1. CONCLUSION Percutaneous transarticular atlantoaxial fixation in elderly patients offers a good minimally invasive operative treatment in this multimorbid group of patients. This new technique with short operative time is well tolerated by the geriatric patients leading to a healing rate up to 88%. LEVEL OF EVIDENCE 4.
Collapse
|
7
|
Ghostine SS, Kaloostian PE, Ordookhanian C, Kaloostian S, Zarrini P, Kim T, Scibelli S, Clark-Schoeb SJ, Samudrala S, Lauryssen C, Gill AS, Johnson PJ. Improving C1-C2 Complex Fusion Rates: An Alternate Approach. Cureus 2017; 9:e1887. [PMID: 29392099 PMCID: PMC5788400 DOI: 10.7759/cureus.1887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The surgical repair of atlantoaxial instabilities (AAI) presents complex and unique challenges, originating from abnormalities and/or trauma within the junction regions of the C1-C2 atlas-axis, to surgeons. When this region is destabilized, surgical fusion becomes of key importance in order to prevent spinal cord injury. Several techniques can be utilized to provide for the adequate fusion of the atlantoaxial construct. Nevertheless, many individuals have less than ideal rates of fusion, below 35%-40%, which also involves the C2 nerve root being sacrificed. This suboptimal and unavoidable iatrogenic complication results in the elevated probability of complications typically composed of vertebral artery injury. This review is a retrospective analysis of 87 patients from Cedars Sinai Medical Center in Los Angeles, California, who had the C1-C2 surgical fusion procedure performed within the time frame from 2001 to 2008, with a mean follow-up period of three years. These patients had presented with typical AAI symptoms of fatigability, limited mobility, and clumsiness. Diagnosis of C1-C2 instability was documented via radiographic studies, typically utilizing computed tomography (CT) scans or x-rays. All patients had bilateral C1 lateral masses and C2 pedicle screws. In addition, the C1-C2 joint was accessed by retracting the C2 nerve root superiorly and exposing the joint by utilizing a high-speed burr. The cavity that is developed within the joint is packed with local autologous bone from the cephalad resection of the C2 laminae. Fusion of the C1-C2 joint was achieved in all patients and a final follow-up was conducted approximately three years postoperative. Of the 87 patients, two presented with occipital headaches resulting from the C1 screws impinging on the C2 nerve root. The issue was rectified by removing instrumentation in both patients after documenting complete fusion via radiographic studies, with complete resolution of symptoms. No vertebral artery or spinal cord injuries were reported as a result of the minor complication. Overall, we aim to describe a safe and reliable alternative technique to fuse C1-C2 instability by focusing on intra-articular arthrodesis complementing instrumentation fixation. This methodology is advantageous from a biomechanical standpoint secondary to axial loading, as well as the large surface area available for arthrodesis. Additionally, this technique does not involve the resection of the C2 nerve root, resulting in low risk for vertebral artery or spinal cord injury.
Collapse
Affiliation(s)
- Samer S Ghostine
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Paul E Kaloostian
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Christ Ordookhanian
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Sean Kaloostian
- Neurological Surgery, University of California, Irvine School of Medicine
| | | | | | | | | | | | - Carl Lauryssen
- Neurological Surgery, St. David's Round Rock Medical Center
| | - Amandip S Gill
- Neurological Surgery, University of California, Riverside School of Medicine
| | | |
Collapse
|
8
|
Wilcox B, Mobbs RJ, Wu AM, Phan K. Systematic review of 3D printing in spinal surgery: the current state of play. JOURNAL OF SPINE SURGERY 2017; 3:433-443. [PMID: 29057355 DOI: 10.21037/jss.2017.09.01] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.
Collapse
Affiliation(s)
- Ben Wilcox
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | - Ai-Min Wu
- Department of Spine Surgery, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second Medical School of the Wenzhou Medical University, Zhejiang Spine Center, Wenzhou 325027, China
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| |
Collapse
|