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Lewis MJ, Early PJ, Bergman R, Love K, Nelson N. Quantification of metallic artifact on CT associated with titanium pedicle screws. Front Vet Sci 2024; 11:1448188. [PMID: 39144086 PMCID: PMC11322838 DOI: 10.3389/fvets.2024.1448188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
Background In dogs undergoing vertebral column stabilization, post-operative computed tomography (CT) evaluates implant placement. The impact on the interpretation of metallic artifact associated with titanium implants in dogs remains to be established. Our objective was to quantify metallic artifact on CT associated with titanium pedicle screws. Methods The study design included an in vitro model and a retrospective review of 11 dogs with vertebral column stabilization. Twenty four titanium pedicle screws (6 each: 2.0 mm, 2.7 mm, 3.5 mm, and 4.5 mm) were inserted into a 20% ballistic gel, and CT scan of the construct was performed. Three blinded raters used a bone window to measure the maximum width (effective size) of each screw, one rater measured effective size using an ultrawide window and 45 titanium pedicle screws (3×2.0 mm, 5×2.7 mm, 30×3.5 mm, and 7×4.5 mm) in 11 clinical cases. Effective size measurements were compared to actual screw sizes. Results The effective size was 26.9-43.8%, 9.2-18.5%, and 21.1-30.5% larger than the actual size for the in vitro system (bone window), in vitro system (ultrawide window), and clinical cases, respectively. The mean gross difference for the in vitro measurements varied by implant size (p < 0.001) and was positively correlated with implant size (r = 0.846), but the mean percentage difference was negatively correlated with implant size (p < 0.001). Overestimation was larger for the in vitro model bone window compared to the ultrawide window (p < 0.001) and clinical cases (p = 0.001). Conclusion Metallic artifact associated with titanium pedicle screws on CT resulted in an overestimation of screw size. This information might aid in the interpretation of implant placement on post-operative imaging.
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Affiliation(s)
- M. J. Lewis
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - P. J. Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - R. Bergman
- Synapse Veterinary Services, Fort Mill, SC, United States
| | - K. Love
- K. R. Love Quantitative Consulting and Collaboration, Athens, GA, United States
| | - N. Nelson
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Driver CJ, Nores VA, Thatcher H, Navarro-Carrillo M, Rose J. Accuracy and safety of freehand vs. end-on fluoroscopic guided drill-hole placement in canine cadaveric thoracic, lumbar and sacral vertebrae. Front Vet Sci 2024; 11:1419521. [PMID: 38938915 PMCID: PMC11210332 DOI: 10.3389/fvets.2024.1419521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Objective To develop and evaluate the safety and accuracy of an open, end-on fluoroscopic guided (EOFG) drill hole position technique in canine cadaveric spinal surgery, in comparison to a traditional free-hand (FH) drilling technique. Study design Cadaveric comparison study. Animals Canine cadaveric vertebral columns (n = 4). Methods Computed tomography (CT) scans were performed for in-silico planning. Ideal implant purchase depth and angulations were determined from previously published data. Plans for end-on fluoroscopic guided drill holes included angled reconstructions in thick slab mode to mimic fluoroscopic images. Following surgical preparation of T8 to S2, holes were drilled by one of two experienced surgeons randomized evenly by operated side, surgeon, and technique. C-arm fluoroscopy was utilized for the end-on technique. CT was repeated after the procedures. Safety was determined categorically using a modified Zdichavsky classification and "optimal" placement was compared between techniques. Continuous data for drill-hole accuracy was calculated as angle and depth deviations from the planned trajectories. Data sets were analyzed at both univariable and multivariable levels with logistic regression analysis. Results Drill hole safety was categorized as optimal (modified Zdichavsky classification 1) in 51/60 (85%) of drill holes using EOFG and 33/60 (55%) using FH (P < 0.001) techniques. There were no "unsafe" holes (modified Zdichavsky classification 3a). Optimal drill hole placement was significantly associated with the EOFG technique and use of the largest cadaver, and was significantly less likely within the thoracic region. Mean angle and depth deviations were significantly lower with the EOFG technique. Angle deviations were significantly lower for EOFG in the lumbar region, whereas bone purchase deviations were significantly lower for EOFG in both the thoracic and lumbar regions. The mean time taken to drill the hole was significantly longer for the EOFG technique. Conclusion Optimal drill hole placement was significantly more likely with the EOFG technique and improved the accuracy of bone purchase in the thoracic region. Clinical significance The EOFG technique shows promise for translation into a clinically setting, potentially improving implant purchase and therefore stabilizing construct strength, whilst potentially reducing the likelihood of neurovascular injury and need for surgical revision.
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Affiliation(s)
- Colin J. Driver
- Lumbry Park Veterinary Specialists, CVS Referrals, Alton, United Kingdom
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Sabol JC, Mariani CL. Implantation Corridors in Canine Thoracic Vertebrae: A Morphometric Study in Dogs of Varying Sizes. Vet Comp Orthop Traumatol 2024; 37:138-144. [PMID: 38253326 DOI: 10.1055/s-0043-1778683] [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: 01/24/2024]
Abstract
OBJECTIVE Surgical stabilization to treat fractures, luxations, and congenital malformations in the thoracic spine can be difficult due to its unique anatomy and surrounding structures. Our objective was to document the morphometrics of the thoracic vertebrae relating to an ideal trajectory for dorsolateral implant placement in a variety of dog sizes and to assess proximity to important adjacent critical anatomical structures using computed tomography (CT) studies. STUDY DESIGN Medical records for 30 dogs with thoracic CT were evaluated. Implantation corridor parameters for thoracic vertebrae (T1-T13) were measured, including the length, width, angle from midline, and allowable deviation angle for corridors simulated using an ideal implant trajectory. The distances from each vertebra to the trachea, lungs, aorta, subclavian artery, and azygos vein were also measured. RESULTS Implantation corridor widths were often very narrow, particularly in the mid-thoracic region, and allowable deviation angles were frequently small. Distances to critical anatomical structures were often less than 1 mm, even in larger dogs. CONCLUSION Thoracic implantation requires substantial precision to avoid breaching the canal, ineffective implant placement, and potential life-threatening complications resulting from invasion of surrounding anatomical structures.
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Affiliation(s)
- Julianna C Sabol
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, United States
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
| | - Christopher L Mariani
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, United States
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, United States
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Violini F, Elford JH, Cardy TJA, Oxley B, Craig A, Behr S. Clinical outcomes of 20 brachycephalic dogs with thoracolumbar spinal deformities causing neurological signs treated with spinal stabilization using 3D-printed patient-specific drill guides. Vet Surg 2024; 53:648-658. [PMID: 38532254 DOI: 10.1111/vsu.14078] [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: 07/25/2023] [Revised: 12/22/2023] [Accepted: 01/28/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To describe the clinical outcomes for pugs and French bulldogs with congenital vertebral malformations, undergoing thoracolumbar spinal stabilization surgery using 3D-printed patient-specific drill guides. To evaluate the accuracy of pedicle screw placement in this group of dogs. STUDY DESIGN Retrospective descriptive study. ANIMALS Twenty dogs (12 pugs and eight French bulldogs). METHODS Medical records searched between August 2018 and March 2021 for pugs and French bulldogs diagnosed with congenital vertebral abnormalities via magnetic resonance imaging (MRI) scan and computed tomography (CT) scan causing T3-L3 myelopathy signs that underwent spinal stabilization surgery using 3D-printed patient-specific drill guides followed by a postoperative CT scan. The short-term outcome was based on the neurological grade (modified Frankel score-MFS) on the day after surgery, day of discharge, and at the follow-up examination at 4 to 6 weeks after surgery. The mid-term outcome was obtained via an online questionnaire (or direct examination in one case). RESULTS Twenty dogs met the inclusion criteria (19/20 grade 2 MFS, 1/20 grade 4 MFS). No complications were reported in the immediate postoperative period and optimal pedicle screw placement was obtained in 169/201 of screws. Twenty-four hours after surgery 16/20 dogs displayed an unchanged neurological grade. Short-term outcomes revealed a static (17/20) or improved (2/20) neurological grade. Ten owners participated in the online questionnaire. All patients were reported to be ambulatory; however, 7/10 dogs displayed abnormal gait. Neurological signs had remained static (6/10) or improved (3/10) in comparison with the dogs' preoperative status at a median of 883.5 days from the surgery. CONCLUSION Dogs in this study had a favorable short-term outcome and mid-term outcome evaluation revealed a static/improved neurological status. CLINICAL SIGNIFICANCE Thoracolumbar spinal stabilization surgery using 3D-printed patient-specific drill guides showed a favorable outcome in brachycephalic breeds affected by vertebral deformities.
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Affiliation(s)
- Francesca Violini
- Willows Veterinary Centre and Referral Service (part of Linnaeus Veterinary Limited), Solihull, UK
| | - James H Elford
- Willows Veterinary Centre and Referral Service (part of Linnaeus Veterinary Limited), Solihull, UK
| | - Thomas J A Cardy
- Cave Veterinary Specialists (part of Linnaeus Veterinary Limited), Somerset, UK
| | | | - Andrew Craig
- North Downs Specialist Referrals, Bletchingley, UK
| | - Sebastien Behr
- Willows Veterinary Centre and Referral Service (part of Linnaeus Veterinary Limited), Solihull, UK
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Lee S, Yi K, Kim N, Heo S. Evaluation of a 3D-Printed Reduction Guide for Minimally Invasive Plate Osteosynthesis of Short Oblique Radial Diaphyseal Fracture in Dogs: A Cadaveric Study. Vet Sci 2024; 11:145. [PMID: 38668413 PMCID: PMC11053707 DOI: 10.3390/vetsci11040145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/05/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens (n = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time.
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Affiliation(s)
| | | | | | - Suyoung Heo
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si 56896, Republic of Korea; (S.L.); (K.Y.); (N.K.)
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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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Jeon JW, Kang KW, Kim WK, Yang S, Kang BJ. Cervical spine reconstruction after total vertebrectomy using customized three-dimensional-printed implants in dogs. J Vet Sci 2024; 25:e2. [PMID: 38311317 PMCID: PMC10839172 DOI: 10.4142/jvs.23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Sufficient surgical resection is necessary for effective tumor control, but is usually limited for vertebral tumors, especially in the cervical spine in small animal neurosurgery. OBJECTIVE To evaluate the primary stability and safety of customized three-dimensional (3D)-printed implants for cervical spine reconstruction after total vertebrectomy. METHODS Customized guides and implants were designed based on computed tomography (CT) imaging of five beagle cadavers and were 3D-printed. They were used to reconstruct C5 after total vertebrectomy. Postoperative CT images were obtained to evaluate the safety and accuracy of screw positioning. After harvesting 10 vertebral specimens (C3-C7) from intact (group A) and implanted spines (group B), implant stability was analyzed using a 4-point bending test comparing with groups A and C (reconstituted with plate and pins/polymethylmethacrylate after testing in Group A). RESULTS All customized implants were applied without gross neurovascular damage. In addition, 90% of the screws were in a safe area, with 7.5% in grade 1 (< 1.3 mm) and 2.5% in grade 2 (> 1.3 mm). The mean entry point and angular deviations were 0.81 ± 0.43 mm and 6.50 ± 5.11°, respectively. Groups B and C significantly decreased the range of motion (ROM) in C3-C7 compared with intact spines (p = 0.033, and 0.018). Both groups reduced overall ROM and neutral zone in C4-C6, but only group B showed significance (p = 0.005, and 0.027). CONCLUSION Customized 3D-printed implants could safely and accurately replace a cervical vertebra in dog cadavers while providing primary stability.
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Affiliation(s)
- Ji-Won Jeon
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
| | - Kyu-Won Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
| | - Woo-Keyoung Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul 08826, Korea
| | - Sook Yang
- CUSMEDI Co., Ltd., Suwon 16675, Korea
| | - Byung-Jae Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul 08826, Korea.
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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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Kang J, Lee S, Heo S, Kim N. Accuracy of a 3-dimensionally printed custom endoscopy port for minimally invasive ventral slot decompression in dogs: A cadaveric study. Vet Surg 2023; 52:1158-1170. [PMID: 36938921 DOI: 10.1111/vsu.13945] [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: 04/19/2022] [Revised: 11/09/2022] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To evaluate the accuracy of a 3-dimensionally (3D)-printed custom endoscopy port (3DEP) for minimally invasive cervical ventral slot decompression. STUDY DESIGN Cadaveric study. ANIMALS Fifteen cadavers of dogs weighing between 3.1 and 34.4 kg. METHODS Minimally invasive cervical ventral slots were created using a 3DEP and an endoscopic system at the C3-C4 intervertebral disc space in each dog by 1 experienced and 1 inexperienced surgeon. Postoperative computed tomography was performed to compare the planned and postoperative screw trajectories (angle, entry point, exit point, and length of the screw entering the spinal canal) and quantify slot formation dimensions. RESULTS Thirty screws were inserted in 30 vertebral bodies. Mean screw angle deviation was less than 2.5°, entry and exit point deviation was less than 1.6 mm, and length of the screw entering the spinal canal was less than 0.6 mm. No differences were identified between the experienced and inexperienced surgeons. Ventral slot length ratio was 30.15 ± 1.86 for the experienced surgeon and 29.38 ± 1.61 for the inexperienced surgeon (p = .372). The mean ventral slot width ratio was 45.60 ± 1.80 for the experienced surgeon and 47.20 ± 1.54 for the inexperienced surgeon (p = .261). CONCLUSION Screw positioning and creation of ventral slots were accurately performed using the 3DEP by both inexperienced and experienced surgeons. CLINICAL SIGNIFICANCE The use of a 3DEP for minimally invasive cervical ventral slot decompression may be an alternative to the conventional ventral slot in dogs. Additional studies are needed to evaluate efficacy and safety.
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Affiliation(s)
- Jinsu Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Seungeon Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Suyoung Heo
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Namsoo Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
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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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Simpson M, Meeson R. Defining the safe corridor for transcondylar screw placement in the feline humeral condyle. J Feline Med Surg 2022; 24:e453-e458. [PMID: 36219455 PMCID: PMC10812328 DOI: 10.1177/1098612x221121899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to develop guidelines for the optimal location of drill entry and exit points for insertion of a transcondylar screw across the feline humeral condyle. METHODS Multiplanar reconstruction of feline elbow CT scans performed between 2016 and 2021 at one referral institution were reviewed. The optimum medial and lateral epicondylar entry and exit points for transcondylar screw placement were determined. These values were normalised to the humeral condylar diameter (HCD) for each elbow to determine the transcondylar screw placement guidelines. These guidelines were applied to each elbow and tolerance angles were determined in the transverse and frontal plane CT images to determine the safe corridor for screw placement. RESULTS Twenty elbows from 12 cats were evaluated in this study. The guidelines for transcondylar screw placement were as follows: the medial entry/exit point was 0.38 × HCD cranial and 0.16 × HCD distal to the medial epicondyle, and the lateral entry/exit point was 0.3 × HCD cranial and 0.16 × HCD distal to the lateral epicondyle. Tolerance angles were statistically significantly (P <0.05) larger in both frontal (34.5% larger) and transverse (21.1% larger) planes when drilled from a lateral to medial direction compared with drilling from a medial to lateral direction. CONCLUSIONS AND RELEVANCE The guidelines determined from this study may aid clinicians in the placement of humeral transcondylar screws in cats. Where possible, drilling from a lateral to medial direction is recommended owing to the higher tolerance angles reducing the likelihood of articular surface damage. Further studies are warranted to determine whether these guidelines are clinically useful and result in the safe insertion of a transcondylar screw in the clinical setting.
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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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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: 3] [Impact Index Per Article: 1.5] [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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Guevar J, Samer ES, Precht C, Rathmann JM, Forterre F. Accuracy and Safety of Neuronavigation for Minimally Invasive Stabilization in the Thoracolumbar Spine Using Polyaxial Screws-Rod: A Canine Cadaveric Proof of Concept. Vet Comp Orthop Traumatol 2022; 35:370-380. [PMID: 35760365 DOI: 10.1055/s-0042-1750056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The main aim of this study was to evaluate the feasibility of minimally invasive stabilization with polyaxial screws-rod using neuronavigation and to assess accuracy and safety of percutaneous drilling of screw corridors using neuronavigation in thoracolumbar spine and compare it between an experienced and a novice surgeon. STUDY DESIGN Feasibility of minimally invasive polyaxial screws-rod fixation using neuronavigation was first performed in the thoracolumbar spine of two dogs. Accuracy and safety of drilling screw corridors percutaneously by two surgeons from T8 to L7 in a large breed dog using neuronavigation were established by comparing entry and exit points coordinates deviations on multiplanar reconstructions between preoperative and postoperative datasets and using a vertebral cortical breach grading scheme. RESULTS Feasibility of minimally invasive stabilization was demonstrated. For the experienced surgeon, safety was 100% and mean (standard deviation) entry point deviations were 0.3 mm (0.8 mm) lateral, 1.3 mm (0.8 mm) ventral and 0.7 mm (1.8 mm) caudal. The exit points deviations were 0.8 mm (1.9 mm) lateral, 0.02 mm (0.9 mm) dorsal and 0.7 mm (2.0 mm) caudal. Significant difference in accuracy between surgeons was found in the thoracic region but not in the lumbar region. Accuracy and safety improvement are noted for the thoracic region when procedures were repeated by the novice. CONCLUSION This proof of concept demonstrates that using neuronavigation, minimally invasive stabilization with polyaxial screws-rod is feasible and safe in a large breed dog model.
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Affiliation(s)
- Julien Guevar
- Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Eva S Samer
- Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Christina Precht
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Franck Forterre
- Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Roh Y, Kim D, Jeong S, Lee H. Evaluation of the accuracy of three-dimensionally printed patient-specific guides for transsphenoidal hypophysectomy in small-breed dogs. Am J Vet Res 2022; 83:465-472. [PMID: 35175933 DOI: 10.2460/ajvr.21.09.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the accuracy of transsphenoidal hypophysectomy using 3-D printed patient-specific guides (3D-PSGs) in small-breed dogs. ANIMALS Heads obtained from the cadavers of 19 small-breed dogs (ex vivo portion of study) and 3 healthy adult (3 to 4 years) purpose-bred Beagles with a median body weight of 9.2 kg. PROCEDURES In the ex vivo study, CT images of the cadavers were collected. The position, width, and length of the pituitary fossa and the pilot hole (insertion angle and place) were measured. Using PSGs, 19 pilot holes were made for the pituitary gland fossa, and CT was performed to assess the position accuracy. In the in vivo study, 3 surgical windows from the pilot holes were made using PSGs. Repeated CT and MRI were performed to evaluate the safeness and effectiveness of PSGs, followed by necropsy. RESULTS In the ex vivo study, the median (interquartile range) difference between the pre- and postoperative insertion angles was 2° (0° to 3.5°) and the median deviation of the pilot hole was 0.46 mm (0 to 1.58 mm). In the in vivo study, the surrounding structures were not damaged, and favorable outcomes were evident in terms of the shape, size, and position of the surgical window. CLINICAL RELEVANCE 3D-PSGs provided a safe and effective surgical window for transsphenoidal hypophysectomy. Our findings emphasized the applicability of PSGs in brain surgery, in terms of accuracy and effectiveness.
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Musser CG, Windsor RC, Wininger F. Corpectomy and spinal stabilization using a 3D-printed spine model and custom jigs to address severe spinal deformities from T9-11 and L2-4 in a 6-month-old German shepherd puppy. Clin Case Rep 2021; 9:e05229. [PMID: 34963810 PMCID: PMC8710705 DOI: 10.1002/ccr3.5229] [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: 04/27/2021] [Revised: 08/22/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022] Open
Abstract
This report describes surgical decompression and stabilization of 2 hemivertebrae in a German shepherd dog. Long-term clinical and imaging outcomes are documented. Spinal cord decompression via corpectomy improved neurological function and intrinsic spinal cord changes on MRI. The dog improved to have minimal paraparesis and an active lifestyle.
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Affiliation(s)
| | | | - Fred Wininger
- Charlotte Animal Referral and EmergencyCharlotteNorth CarolinaUSA
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Altwal J, Wilson CH, Griffon DJ. Applications of 3-dimensional printing in small-animal surgery: A review of current practices. Vet Surg 2021; 51:34-51. [PMID: 34633081 DOI: 10.1111/vsu.13739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 01/25/2023]
Abstract
Three-dimensional (3D) printing, also called rapid prototyping or additive manufacturing, transforms digital images into 3D printed objects, typically by layering consecutive thin films of material. This technology has become increasingly accessible to the public, prompting applications in veterinary surgery. Three-dimensional prints provide direct visualization of complex 3D structures and also haptic feedback relevant to surgery. The main objective of this review is to report current applications of 3D printing in small-animal surgery, including surgical education, preoperative planning, and treatment of tissue defects. The reported uses of 3D prints, their proposed advantages, and current limitations are discussed considering published evidence. Aspects of the manufacturing process specific to each application are described, along with current practices in veterinary surgery.
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Affiliation(s)
- Johnny Altwal
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Schmid College of Science and Technology, Chapman University, Orange, California, USA
| | - Caroline H Wilson
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, California, USA
| | - Dominique J Griffon
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
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Schmitt EM, Early P, Bergman R, Riedesel EA, Yuan L, Mochel JP, Kraus KH. Computed tomography evaluation of proposed implant corridors in canine thoracic vertebrae. Vet Surg 2021; 50:1427-1433. [PMID: 34251686 DOI: 10.1111/vsu.13680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 05/01/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identify acceptable implant corridors in the normal canine thoracic vertebrae (T) from T1 to T9. STUDY DESIGN Retrospective study. SAMPLE POPULATION Computed tomographic (CT) studies of normal canine thoracic spines (n = 39). METHODS CT imaging studies of normal T1-T9 canine spines were evaluated by five independent observers. Each identified a proposed corridor, measured the width, length, and angle off mid-sagittal that the corridor occupied. RESULTS CT studies were from 39 dogs weighing 3.19-60 kg (mean 10.72, SD 9.9 kg). Vertebral corridors ranged in average width from 3.8 to 5.2 mm, the widest being located at T1. They ranged in average length from 13.3 to 17.5 mm, shortest being T1 and longest being T6. The angle of corridors varied the most between individual vertebrae at T1-T3. The average corridor angles were: T1 = 38°, T2 = 32°, T3 = 27°, T4 = 26°. T5-T9 angle ranged from 23° to 24°. CONCLUSION The average dimensions of corridors measured in dogs weighing 3.1-60 kg were consistent with those of commercially available cortical screws and pins. CLINICAL SIGNIFICANCE Corridor trajectories identified in this population can be achieved from a dorsal approach between T5 and T9. A dorsal approach for implant placement would be challenging for T1-T4 due to the variability found in these vertebrae as well as regional anatomical constraints.
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Affiliation(s)
- Elizabeth M Schmitt
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
| | - Peter Early
- Department of Clinical Sciences, NC State University Veterinary Hospital, Raleigh, North Carolina, USA
| | - Robert Bergman
- Veterinary Neurology and Neurosurgery, Carolina Veterinary Specialists, Rock Hill, South Carolina, USA
| | - Elizabeth A Riedesel
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
| | - Karl H Kraus
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
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