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Scheuermann LM, Lewis DD, Johnson MD, Biedrzycki AH, Kim SE. Efficacy of virtual surgical planning and a three-dimensional-printed, patient-specific reduction system to facilitate alignment of diaphyseal tibial fractures stabilized by minimally invasive plate osteosynthesis in dogs: A prospective clinical study. Vet Surg 2024; 53:1039-1051. [PMID: 38850094 DOI: 10.1111/vsu.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/19/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To evaluate the efficacy of a three-dimensional (3D)-printed, patient-specific reduction system for aligning diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO). STUDY DESIGN Prospective clinical trial. SAMPLE POPULATION Fifteen client owned dogs. METHODS Virtual 3D models of both pelvic limbs were created. Pin guides were designed to conform to the proximal and distal tibia. A reduction bridge was designed to align the pin guides based on the guides' spatial location. Guides were 3D printed, sterilized, and applied, in conjunction with transient application of a circular fixator, to facilitate indirect fracture realignment before plate application. Alignment of the stabilized tibiae was assessed using postoperative computed tomography scans. RESULTS Mean duration required for virtual planning was 2.5 h and a mean of 50.7 h elapsed between presentation and surgery. Guide placement was accurate with minor median discrepancies in translation and frontal, sagittal, and axial plane positioning of 2.9 mm, 3.6°, 2.7°, and 6.8°, respectively. Application of the reduction system restored mean tibial length and frontal, sagittal, and axial alignment within 1.7 mm, 1.9°, 1.7°, and 4.5°, respectively, of the contralateral tibia. CONCLUSION Design and fabrication of a 3D-printed, patient-specific fracture reduction system is feasible in a relevant clinical timeline. Intraoperative pin-guide placement was reasonably accurate with minor discrepancies compared to the virtual plan. Custom 3D-printed reduction system application facilitated near-anatomic or acceptable fracture reduction in all dogs. CLINICAL SIGNIFICANCE Virtual planning and fabrication of a 3D-printing patient-specific fracture reduction system is practical and facilitated acceptable, if not near-anatomic, fracture alignment during MIPO.
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Affiliation(s)
- Logan M Scheuermann
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew D Johnson
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Adam H Biedrzycki
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences and the Jeff and Jo Godwin Advanced Small Animal Surgical Training Center and Canine Gait Laboratory, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Guevara F, Foss KD, Harper TAM, Moran CA, Hague DW, Hamel PES, Schaeffer DJ, McCoy AM. Ex vivo comparison of pin placement with patient-specific drill guides or freehand technique in canine cadaveric spines. Vet Surg 2024; 53:254-263. [PMID: 37822110 DOI: 10.1111/vsu.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare vertebral implant placement in the canine thoracolumbar spine between 3D-printed patient-specific drill guides (3DPG) and the conventional freehand technique (FH). STUDY DESIGN Ex vivo study. ANIMALS Cadaveric canine spines (n = 24). METHODS Implant trajectories were established for the left and right sides of the T10 through L6 vertebrae based on computed tomography (CT) imaging. Customized drill guides were created for each vertebra of interest. Each cadaver was randomly assigned to one of six veterinarians with varying levels of experience placing vertebral implants. Vertebrae were randomly assigned a surgical order and technique (3DPG or FH) for both sides. Postoperative CT images were acquired. A single, blinded observer assessed pin placement using a modified Zdichavsky classification. RESULTS A total of 480 implants were placed in 240 vertebrae. Three sites were excluded from the analysis; therefore, a total of 238 implants were evaluated using the FH technique and 239 implants using 3DPG. When evaluating implant placement, 152/239 (63.6%) of 3DPG implants were considered to have an acceptable placement in comparison with 115/248 (48.32%) with FH. Overall, pin placement using 3DPG was more likely to provide acceptable pin placement (p < .001) in comparison with the FH technique for surgeons at all levels of experience. CONCLUSION The use of 3DPG was shown to be better than the conventional freehand technique regarding acceptable placement of implants in the thoracolumbar spine of canine cadavers. CLINICAL SIGNIFICANCE Utilizing 3DPG can be considered better than the traditional FH technique when placing implants in the canine thoracolumbar spine.
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Affiliation(s)
- Francisco Guevara
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Kari D Foss
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Tisha A M Harper
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Clara A Moran
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Devon W Hague
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Philip E S Hamel
- Boundary Bay Veterinary Specialty Hospital, Langley, British Columbia, Canada
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
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Marturello DM, Déjardin LM. Post-sterilization Dimensional Accuracy of Methacrylate Monomer Biocompatible Three-Dimensionally Printed Mock Surgical Guides. Vet Comp Orthop Traumatol 2023; 36:279-286. [PMID: 37327880 DOI: 10.1055/s-0043-1768991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the post-sterilization dimensional accuracy of a standardized drilling guide, three-dimensionally printed using biocompatible methacrylate monomers. STUDY DESIGN A mock surgical guide was designed and printed in five resins (n = 5/material) using a commercially available desktop stereolithography printer. Pre- and post-sterilization dimensions were measured for each sterilization method (steam, ethylene oxide, hydrogen peroxide gas), then statistically compared; p-value less than or equal 0.05 was considered significant. RESULTS While all resins produced highly accurate replicas of the designed guide, the amber and black resins were unaffected by any sterilization method (p ≥ 0.9). For other materials, ethylene oxide produced the largest dimensional changes. However, mean post-sterilization dimensional changes for all materials and sterilization methods remained less than or equal to 0.05mm CONCLUSION: This study demonstrated that post-sterilization dimensional change of evaluated biomaterials was minimal, and less than previously reported. Additionally, amber and black resins may be preferred to reduce post-sterilization dimensional change, as they were unaffected by any sterilization method. Given the results of this study, surgeons should feel confident using the Form 3B printer to create patient surgical guides. Furthermore, bioresins may provide safer alternatives for patients compared with other three-dimensional printed materials.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
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Mullins RA, Espinel Ruperéz J, Bleedorn J, Hoey S, Hetzel S, Ortega C, Kraus KH, Guevar J. Accuracy of pin placement in the canine thoracolumbar spine using a free-hand probing technique versus 3D-printed patient-specific drill guides: An ex-vivo study. Vet Surg 2023; 52:648-660. [PMID: 37071824 DOI: 10.1111/vsu.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To compare pin placement accuracy, intraoperative technique deviations, and duration of pin placement for pins placed by free-hand probing (FHP) or 3D-printed drill guide (3DPG) technique. SAMPLE POPULATION Four greyhound cadavers. METHODS Computed tomography (CT) examinations from T6-sacrum were obtained for determination of optimal pin placement and 3DPG creation. Two 3.2/2.4-mm positive profile pins were inserted per vertebra, one left and one right from T7-L7 (FHP [n = 56]; 3DPG [n = 56]) by one surgeon and removed for repeat CT. Duration of pin placement and intraoperative deviations (unanticipated deviations from planned technique) were recorded. Pin tracts were graded by two blinded observers using modified Zdichavsky classification. Descriptive statistics were used. RESULTS A total of 54/56 pins placed with 3DPGs were assigned grade I (optimal placement) compared with 49/56 pins using the FHP technique. A total of 2/56 pins placed with 3DPGs and 3/56 pins using the FHP technique were assigned grade IIa (partial medial violation). A total of 4/56 pins placed using the FHP technique were assigned grade IIIa (partial lateral violation). No pins were assigned grade IIb (full medial violation). Intraoperative technique deviations occurred with 6/56 pins placed using the FHP technique and no pins with 3DPGs. Overall, pins were placed faster (mean ± SD 2.6 [1.3] vs. 4.5 [1.8] min) with 3DPGs. CONCLUSIONS Both techniques were accurate for placement of spinal fixation pins. The 3DPG technique may decrease intraoperative deviations and duration of pin placement. CLINICAL RELEVANCE Both techniques allow accurate pin placement in the canine thoracolumbar spine. The FHP technique requires specific training and has learning curve, whereas 3DPG technique requires specific software and 3D printers.
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Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Jorge Espinel Ruperéz
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Jason Bleedorn
- Department of Veterinary Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Seamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Cristina Ortega
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Karl H Kraus
- Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Iowa, USA
| | - Julien Guevar
- Division of Surgery, Department of Clinical Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Fracka AB, Oxley B, Allen MJ. 3D-printed, patient-specific cutting guides improve femoral and tibial cut alignment in canine total knee replacement. Vet Surg 2023; 52:674-685. [PMID: 37114865 DOI: 10.1111/vsu.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/18/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES The purpose of this cadaveric study was to determine whether patient-specific guides (PSGs) improve the accuracy of tibial and femoral cut alignment in canine total knee replacement (TKR), as compared with generic cutting guides. STUDY DESIGN Original research. ANIMALS Sixteen pelvic limbs from skeletally mature medium- to large-breed canine cadavers. METHODS Specimens were randomly allocated to one of two groups (PSG or Generic; N = 8/group). In the Generic group, femoral and tibial ostectomies were made using the standard canine TKR femoral cutting blocks and tibial alignment guide. In the PSG group, the cuts were made using a series of custom 3D-printed cutting guides. "Planned" and "actual" tibial and femoral cut alignments were compared in the frontal and sagittal planes, and errors were calculated by subtracting actual from planned values. RESULTS Use of 3D-printed PSGs improved tibial cut alignment in the frontal plane but not the sagittal plane. PSGs also improved the alignment of the cranial and distal femoral ostectomies but did not impact varus-valgus alignment. CONCLUSIONS These findings support the use of PSGs for TKR in dogs. Clinical trials are now needed to determine whether the benefits of PSGs translate into measurable improvements in joint function and implant longevity. CLINICAL SIGNIFICANCE PSGs have the potential to improve femoral and tibial component alignment in canine TKR.
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Affiliation(s)
- Agnieszka B Fracka
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Matthew J Allen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Gilman O, Escauriaza L, Ogden D, Vandenberghe H, Roper D, Oxley B, Granger N. Thoracolumbar Spinal Stabilization with Three Dimensional-Printed Drill Guides and Pre-Contoured Polyaxial Bone Plates. Vet Comp Orthop Traumatol 2023; 36:46-52. [PMID: 36414002 DOI: 10.1055/s-0042-1756514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to report new preoperative and intraoperative techniques performed for canine thoracic or lumbar spine kyphosis stabilization using three-dimensional-printed patient-specific drill guides, polyaxial titanium bone plates and drill stops, and to determine the accuracy of screw placement using these techniques. STUDY DESIGN Retrospective study, five client-owned dogs. RESULTS Three-dimensional-printed patient-specific drill guides and drill stops allowed safe drilling and screw placement in all of the cases, with (i) 84% of the screws graded as I (ideal placement) and 16% as IIa, IIIa or IIIb according to the modified Zdichavsky classification (partial penetration of medial pedicle wall, partial penetration of lateral pedicle wall and full penetration of lateral pedicle wall respectively), (ii) mean mediolateral deviation of ± 4.06 degrees (standard deviation: 8.21 degrees) compared to planned trajectories and (iii) variation in screw depth of ± 2.29mm (standard deviation: 3.07mm) compared to planned depth. CONCLUSION We believe that the techniques presented here for thoracic spinal stabilization in dogs show promise; they allowed safe placement of screws along planned trajectories and depth; they also removed the need to use polymethylmethacrylate, while the use of titanium offers the possibility to repeat magnetic resonance imaging in these cases with chronic spinal conditions.
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Affiliation(s)
- Oliver Gilman
- Bristol Veterinary Specialists at Highcroft, CVS Referrals, United Kingdom
| | - Leticia Escauriaza
- Bristol Veterinary Specialists at Highcroft, CVS Referrals, United Kingdom
| | - Dan Ogden
- Bristol Veterinary Specialists at Highcroft, CVS Referrals, United Kingdom
| | | | - Darren Roper
- Bristol Veterinary Specialists at Highcroft, CVS Referrals, United Kingdom
| | | | - Nicolas Granger
- Bristol Veterinary Specialists at Highcroft, CVS Referrals, United Kingdom
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Yu Y, Kang J, Kim N, Heo S. Accuracy of a patient-specific 3D-printed drill guide for placement of bicortical screws in atlantoaxial ventral stabilization in dogs. PLoS One 2022; 17:e0272336. [PMID: 35913954 PMCID: PMC9342780 DOI: 10.1371/journal.pone.0272336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Atlantoaxial instability (AAI) in dogs refers to abnormal motion at the C1–C2 articulation due to congenital or developmental anomalies. Surgical treatment options for AAI include dorsal and ventral stabilization techniques. Ventral stabilization techniques commonly utilize transarticular and vertebral body screws or pins. However, accurate screw insertion into the vertebrae of C1 and C2 is difficult because of the narrow safety corridors. This study included 10 mixed dogs, 1 Pomeranian, and 1 Shih-Tzu cadaver. All dogs weighed <10 kg. Each specimen was scanned using computed tomography (CT) from the head to the 7th cervical vertebrae. This study used 12 bone models and 6 patient-specific drill guides. Bone models were made using CT images and drill guides were created through a CAD (computer-aided design) program. A total of six cortical screws were used for each specimen. Two screws were placed at each of the C1, C2 cranial, and C2 caudal positions. Postoperative CT images of the cervical region were obtained. The degree of cortex breaching and angle and bicortical status of each screw was evaluated. The number of screws that did not penetrate the vertebral canal was higher in the guided group (33/36, 92%) than in the control group (20/36, 56%) (P = 0.003). The screw angles were more similar to the reference angle compared to the control group. The number of bicortically applied screws in the control group was 28/36 (78%) compared to 34/36 (94%) in the guided group. Differences between the preoperative plan and the length of the applied screw at the C1 and C2 caudal positions were determined by comparing the screw lengths in the guide group. The study results demonstrated that the use of a patient-specific 3D-printed drill guide for AAI ventral stabilization can improve the accuracy of the surgery. The use of rehearsal using bone models and a drilling guide may improve screw insertion accuracy.
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Affiliation(s)
- Yong Yu
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Jinsu Kang
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Namsoo Kim
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Suyoung Heo
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
- * E-mail:
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Gutmann S, Flegel T, Müller M, Möbius R, Matiasek K, König F, Winkler D, Grunert R. Case Report: Clinical Use of a Patient-Individual Magnetic Resonance Imaging-Based Stereotactic Navigation Device for Brain Biopsies in Three Dogs. Front Vet Sci 2022; 9:876741. [PMID: 35915727 PMCID: PMC9337988 DOI: 10.3389/fvets.2022.876741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Three-dimensional (3D) printing techniques for patient-individual medicine has found its way into veterinary neurosurgery. Because of the high accuracy of 3D printed specific neurosurgical navigation devices, it seems to be a safe and reliable option to use patient-individual constructions for sampling brain tissue. Due to the complexity and vulnerability of the brain a particularly precise and safe procedure is required. In a recent cadaver study a better accuracy for the 3D printed MRI-based patient individual stereotactic brain biopsy device for dogs is determined compared to the accuracies of other biopsy systems which are currently used in veterinary medicine. This case report describes the clinical use of this 3D printed MRI-based patient individual brain biopsy device for brain sampling in three dogs. The system was characterized by a simple handling. Furthermore, it was an effective and reliable tool to gain diagnostic brain biopsy samples in dogs with no significant side effects.
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Affiliation(s)
- Sarah Gutmann
- Department for Small Animals, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
- *Correspondence: Sarah Gutmann
| | - Thomas Flegel
- Department for Small Animals, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Marcel Müller
- Medical Engineering, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - Robert Möbius
- Department for Neurosurgery, University Hospital Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Florian König
- Small Animal Practice, Neurology, Wiesbaden, Germany
| | - Dirk Winkler
- Department for Neurosurgery, University Hospital Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Ronny Grunert
- Medical Engineering, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
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Bongers JJ, Wilkinson N, Kurihara M, Bridges JP, Baltzer W, Worth AJ. Accuracy of Lumbosacral Pedicle Screw Placement in Dogs: A Novel 3D Printed Patient-Specific Drill Guide versus Freehand Technique in Novice and Expert Surgeons. Vet Comp Orthop Traumatol 2022; 35:381-389. [PMID: 35815627 DOI: 10.1055/s-0042-1750433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of pedicle screw placement at the canine lumbosacral junction using a novel unilateral three-dimensional printed patient-specific guide (3D-PSG) versus a freehand drilling technique. Additionally, accuracy of screw placement between a novice and an experienced surgeon was determined. STUDY DESIGN Preoperative computed tomography images from 20 lumbosacral cadaveric specimens were used to design a novel unilateral 3D-PSG for the L7 and sacral vertebrae which was printed in acryl-nitrile butadiene styrene plastic. A novice and an expert surgeon each placed 3.5mm cortical screws in 10 cadavers; on the left using the unilateral 3D-PSG and by the freehand (anatomic landmark) technique on the right. RESULTS Sixty screws were placed using the unilateral 3D-PSG and 60 using the freehand technique. There was no statistical difference in accuracy for the comparison between methods performed by the expert (p = 0.679) and novice (p = 0.761) surgeon, nor between an expert and novice surgeon overall (p = 0.923). Unexpectedly, the use of a unilateral 3D-PSG increased variability for the expert surgeon in our study (p = 0.0314). CONCLUSION Using a novel unilateral 3D-PSG did not improve the accuracy of screw placement for lumbosacral stabilization by a novice surgeon compared with an expert surgeon in lumbar spine surgery. This may reflect a suboptimal PSG design.
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Affiliation(s)
- Jos J Bongers
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Nathan Wilkinson
- Axia 3D Design, (currently Nexus Engineering & Design Ltd), Napier, New Zealand
| | - Manabu Kurihara
- Cummings School of Veterinary Medicine at Tufts University, Crafton, United States
| | - Janis P Bridges
- Massey University School of Veterinary Science, Palmerston North, New Zealand
| | - Wendy Baltzer
- University of Sydney, School of Veterinary Science, Sydney, New South Wales, Australia
| | - Andrew J Worth
- Massey University School of Veterinary Science, Palmerston North, New Zealand
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Farré Mariné A, Pumarola M, Luján Feliu-Pascual A. Polysulfone tailor-made implant for the surgical correction of a frontoparietal meningoencephalocoele in a cat. JFMS Open Rep 2022; 8:20551169221098940. [PMID: 35693478 PMCID: PMC9178977 DOI: 10.1177/20551169221098940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Case summary A 6-week-old entire female domestic shorthair cat was presented for evaluation of a soft bulge and a palpable skull defect on the forehead, present since adoption a few days earlier. The neurological examination revealed an absent menace response bilaterally and apparent blindness, localising the lesion to the occipital cortex. The main differential diagnoses were meningocoele (MC) and meningoencephalocoele (MEC). Surgical repair was proposed once the cat reached adult size. Meanwhile, the cat developed seizures and was treated with anticonvulsant therapy. At 6 months of age, CT confirmed a frontoparietal MEC with associated porencephaly. Based on a three-dimensional printed skull mould, a polysulfone implant was created. The meninges were dissected from the skin, a durectomy was performed and samples of the protruding brain were obtained. Part of the cerebrospinal fluid was drained until the size of the protruding brain decreased enough to be included below the implant that was anchored on top of the skull with cerclages. Histopathology confirmed the diagnosis of MEC. Three years and 7 months later, the cat had partially recovered vision but continued to seize monthly despite antiepileptic drugs. Relevance and novel information MC/MEC is a relatively uncommon disease reported in companion animals, and only four cases of surgical management have been described, and did not use a polysulfone tailor-made implant. In human medicine, surgical intervention is the treatment of choice. This case highlights a new implant option for surgical correction of MEC with good long-term result and no complications after 3 years and 7 months.
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Evaluation of a Novel Dorsal-Cemented Technique for Atlantoaxial Stabilisation in 12 Dogs. Life (Basel) 2021; 11:life11101039. [PMID: 34685410 PMCID: PMC8539997 DOI: 10.3390/life11101039] [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: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Dorsal atlantoaxial stabilisation (DAAS) has mostly been described to treat atlantoaxial instability using low stiffness constructs in dogs. The aim of this study was to assess the feasibility and surgical outcome of a rigid cemented DAAS technique using bone corridors that have not previously been reported. The medical records of 12 consecutive dogs treated with DAAS were retrospectively reviewed. The method involved bi-cortical screws placed in at least four of eight available bone corridors, embedded in polymethylmethacrylate. Screw placement was graded according to their position and the degree of the breach from the intended bone corridor. All DAAS procedures were completed successfully. A total of 72 atlantoaxial screws were placed: of those, 51 (70.8%) were optimal, 17 (23.6%) were suboptimal, and 4 (5.6%) were graded as hazardous (including 2 minor breaches of the vertebral canal). Surgical outcome was assessed via a review of client questionnaires, neurological examination, and postoperative CT images. The clinical outcome was considered good to excellent in all but one case that displayed episodic discomfort despite the appropriate atlantoaxial reduction. A single construct failure was identified despite a positive clinical outcome. This study suggests the proposed DAAS is a viable alternative to ventral techniques. Prospective studies are required to accurately compare the complication and success rate of both approaches.
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Gilbert E, Driver CJ. Surgical management of traumatic atlantoaxial subluxation in two cats. JFMS Open Rep 2021; 7:20551169211027070. [PMID: 34285810 PMCID: PMC8264740 DOI: 10.1177/20551169211027070] [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] [Indexed: 11/15/2022] Open
Abstract
Case series summary We describe here the surgical management of two pure breed cats with traumatic atlantoaxial subluxation. One cat was ambulatory tetraparetic on presentation and the second was tetraplegic, both with cervical spinal pain and acute onset of paresis with subsequent deterioration. MRI was performed in both cases, demonstrating spinal cord injury. Flexed lateral cervical radiographs were needed to confirm atlantoaxial subluxation in one case. CT was performed for surgical planning and surgical stabilisation was achieved with threaded pins and polymethyl methacrylate (PMMA) cement; odontoidectomy was required in one case. Both cats showed improvement postoperatively, with no complications or deterioration seen. Following surgery, one cat made a complete recovery; however, the second cat retained significant deficits. Relevance and novel information We present the first report of surgically managed atlantoaxial subluxation of traumatic aetiology in cats, and report its occurrence in two novel breeds for this disease, Ragdoll and Persian. One case required odontoidectomy due to previous fracture and malunion of the odontoid process of the axis; both cases underwent surgical stabilisation of the atlantoaxial joint utilising multiple threaded pins and PMMA cement without transarticular implants – a technique that has not been previously reported in cats.
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Gilbert E, Driver C. Traumatic atlantoaxial subluxation associated with congenital aplasia of the odontoid process of the axis in an English Springer Spaniel. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Emma Gilbert
- Lumbry Park Veterinary Specialists ‐ Neurology Alton UK
| | - Colin Driver
- Lumbry Park Veterinary Specialists ‐ Neurology Alton UK
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