Preparation and Assessment of an Individualized Navigation Template for Lower Cervical Anterior Transpedicular Screw Insertion Using a Three-Dimensional Printing Technique.
Spine (Phila Pa 1976) 2018;
43:E348-E356. [PMID:
28742761 DOI:
10.1097/brs.0000000000002341]
[Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN
Prospective trial.
OBJECTIVE
To establish an individualized navigation template for safe and accurate insertion of lower cervical anterior transpedicular screw (ATPS) based on a three-dimensional (3D) printing technique.
SUMMARY OF BACKGROUND DATA
Conventional screw insertion manually under fluoroscopy easily leading to deviation of ATPS screw channel, cervical instrumentation procedures demand the need for a precise technique for screw placement.
METHODS
Twenty adult cervical spine specimens (10 men and 10 women, with a mean age of 50.29 ± 6.98) were selected for computed tomography pre- and postoperatively. A 3D lower cervical spine model was reconstructed using Mimics software to measure the screw-related parameters and generate a reverse template with optimal screw channel as well as a prototype using 3D printing. Assisted by the navigation template, bilateral ATPS were inserted into the cadavers.
RESULTS
The mean outer width and height of pedicle were 5.31 ± 1.23 and 6.78 ± 1.10 mm, respectively. The average length, sagittal, and axial angles of the optimal screw channel obtained through the optimal entry point were 36.34 ± 4.39 mm, 40.67° ± 5.10°, and 93.7° ± 7.96°, respectively. The adjustable safe ranges of sagittal and axial angles were 3.89° ± 1.13° and 5.64° ± 0.97°, respectively. The axial and sagittal accuracies of the 200 screws were 99.5% and 97%, respectively. The average deviations of the actual entry point and the preset opening in the X, Y, and Z axes were 0.39 ± 0.43, 0.21 ± 0.41, and 0.29 ± 0.14 mm, respectively (P > 0.05).
CONCLUSION
An individualized ATPS navigation template was developed using Mimics software and 3D printing prototyping, based on computed tomography, for highly accurate screw insertion.
LEVEL OF EVIDENCE
4.
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