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Ding B, Zhou T, Ma H, Zhao J. A novel radiographic analysis system for subaxial cervical spine pedicle screw placement. J Orthop Surg Res 2023; 18:581. [PMID: 37553693 PMCID: PMC10408217 DOI: 10.1186/s13018-023-03999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Precise pedicle screw placement of the subaxial cervical spine is difficult. Not every hospital is equipped with a guidance system that can provide effective help. Computed tomography (CT) scanning is almost a routine preoperative examination for cervical spine surgery in all hospitals. Appropriate measurement and analysis of the CT images could assist optimal cervical pedicle screw placement. The purpose of this study is to propose a new and universal method using computed tomography (CT) morphological parameters analysis to assist optimal cervical pedicle screw placement from C3 to C7. METHODS A localization system with six parameters was designed based on preoperative CT reconstruction to guide subaxial cervical spine pedicle screw placement. The six parameters were distance from the starting point to the midline [D1], distance from the starting point to the lower edge of the inferior articular process [D2], transverse section angle [TSA], sagittal section angle [SSA], pedicle width [PW], and pedicle height [PH]. The six parameters were analyzed in 53 participants. RESULTS Combining D1 and D2 could localize the entrance of the pedicle screw, and we concluded that D1 and TSA and D2 and SSA could be a new standard for determination of the transverse and sagittal orientation of the pedicle screw. The six parameters were closely related to the patient's gender, height, and weight. PH and PW were linearly correlated and could guide selection of the appropriate pedicle screw. SSA was an independent parameter of the relevant vertebral body, and changes in SSA had nothing to do with the curvature or posture of the cervical spine. CONCLUSIONS Understanding and applying the six-parameter localization system are essential for achieving accurate and optimal pedicle screw placement in subaxial cervical spine, regardless of cervical sagittal alignment.
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Affiliation(s)
- Baozhi Ding
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Hui Ma
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
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Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
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Wang L, Zhao L, Gu Y, Yu L, Ma W, Xu R. Effectiveness of 2 Types of Drill Templates for Cervical Anterior Transpedicular Screw Placements: A Comparative Study. World Neurosurg 2020; 147:e343-e350. [PMID: 33346054 DOI: 10.1016/j.wneu.2020.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate effectiveness of regular and modified drill templates used to guide cervical anterior transpedicular screw (ATPS) placement. METHODS This study included 15 adult cadaveric specimens. Computed tomography images were imported into Mimics software. Three-dimensional modeling of all cervical vertebrae was done, and the ideal trajectories were designed for ATPSs. Models of regular and modified templates were designed for every level on the left or right side randomly. After three-dimensional printing, 2 types of templates were used to guide the insertion. Postoperative computed tomography scans were used to measure deviations between real and ideal trajectories in the direction and positioning of entry points. The deviations in the 2 groups were compared using paired t test. RESULTS There were 120 templates and ATPSs fabricated and placed. Postoperative images showed that 7 screws perforated pedicles in the regular group, with an accuracy rate of 88.3%. Deviations between real and ideal trajectories in cranially inclined angles and extroversive angles were 1.13° ± 0.61° and 0.97° ± 0.60°, respectively, and deviations of entry point position in the x-axis and y-axis were 0.72 ± 0.38 mm and 0.95 ± 0.47 mm, respectively. In the modified group, there were 2 malposition screws with accuracy rate of 96.7%. Deviations in cranially inclined angles were 0.66° ± 0.53° and 0.66° ± 0.55° in extroversive angles, respectively, and deviations in entry point positions in the x-axis and y-axis were 0.45 ± 0.37 mm and 0.51 ± 0.34 mm, respectively. The differences in deviations between groups were statistically significant. CONCLUSIONS Compared with regular drill templates, modified drill templates can provide higher accuracy and stronger trajectory control in ATPS insertions.
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Affiliation(s)
- Liran Wang
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Liujun Zhao
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China.
| | - Yongjie Gu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Liang Yu
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Rongming Xu
- Department of Orthopedics, Mingzhou Hospital of Zhejiang University, Ningbo, China
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Zhuang YD, Zhou MC, Liu SC, Wu JF, Wang R, Chen CM. Effectiveness of personalized 3D printed models for patient education in degenerative lumbar disease. PATIENT EDUCATION AND COUNSELING 2019; 102:1875-1881. [PMID: 31113688 DOI: 10.1016/j.pec.2019.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/09/2019] [Accepted: 05/04/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Three-dimensional printing may play an important role in patients' education. The objective of this study was to assess the effectiveness of personalized 3D printed models for increasing patient understanding of their medical condition and surgical plan. METHODS Forty-five patients with degenerative lumbar diseases were randomized by block design into three groups: educational program presented by CT & MRI imaging (care-as-usual), 3D reconstructions, or personalized 3D printed models. Patients' level of understanding and satisfaction were evaluated by two questionnaires one day after education. RESULTS Patients educated with personalized 3D printed models demonstrated an expanded level of understanding than patients educated with CT & MRI imaging (care-as-usual) (P < 0.05) and 3D reconstructions (P < 0.05). Personalized 3D printed models also resulted in a higher degree of patient satisfaction (P < 0.05). CONCLUSIONS Personalized 3D printed models and 3D reconstructions can simplify and enhance understanding of lumbar anatomy, physiology, and patients' disease and surgical plan. Personalized 3D printed models also enhance patients' subjective satisfaction. PRACTICE IMPLICATIONS Personalized 3D printed models for patient education are feasible and could be generalized for degenerative lumbar diseases.
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Affiliation(s)
- Yuan-Dong Zhuang
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China
| | - Mao-Chao Zhou
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China
| | - Shi-Chao Liu
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China
| | - Jian-Feng Wu
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China
| | - Rui Wang
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Union Hospital, Fujian Medical University, Fujian Institute of Neurosurgery, Fuzhou 350001, China.
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Zhang YW, Zeng T, Gao WC, Xiao X, Xiao Y, Chen X, Zhang SL, Deng L. Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review. Med Sci Monit 2019; 25:6281-6290. [PMID: 31432800 PMCID: PMC6714593 DOI: 10.12659/msm.918061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.
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Affiliation(s)
- Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China (mainland).,Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Ting Zeng
- Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Wen-Cheng Gao
- Department of Orthopedics, Dongguan Houjie Town People's Hospital, Dongguan, Guangdong, China (mainland)
| | - Xin Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Yan Xiao
- Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Xi Chen
- Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Su-Li Zhang
- Department of Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu, China (mainland)
| | - Liang Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China (mainland)
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Lin L, Zhu M, Peng P, Zhang X, Zhou X, Li J. Patient-specific drill template for C2 transoral pedicle insertion in complete reduction of atlantoaxial dislocation: cadaveric efficacy and accuracy assessments. J Orthop Surg Res 2019; 14:141. [PMID: 31096990 PMCID: PMC6524296 DOI: 10.1186/s13018-019-1189-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background The transoral atlantoaxial reduction plate (TARP) is an effective advance in the treatment of atlantoaxial dislocation (AAD) and can enable the performance of anterior atlantoaxial release, reduction, decompression, and internal fixation in a one-stage operation. However, accurate transoral C2 pedicle insertion (C2TOPI) remains a challenge. The aim of this study is to develop a grouped patient-specific drill template (PDT) specifically for AAD with complete reduction and, furthermore, to compare its efficacy and accuracy in facilitating C2TOPI. Methods After CT scanning, ten cadaveric C2 specimens were randomly assigned to two groups (the PDT and freehand group). A grouped PDT specifically for AAD with complete reduction was designed and manufactured. C2TOPI was performed using the PDT or the fluoroscopy-guided freehand technique. Postoperative CT scans were subsequently performed to analyze the deviations at the centroid of the cross section at the midpoint of the pedicle. Screw position grades were also assessed in both groups. Results Compared to the freehand group, the PDT group had a significantly shorter surgery time (p < 0.001). Significant differences between the two groups were observed in the absolute value of the deviations at the centroid of the pedicle on either the axial or sagittal planes (p < 0.05). No significant difference was found in the screw positions between the two groups (p > 0.05); however, two unacceptable breaches (20%) occurred in the freehand group. Conclusion A specifically designed PDT could provide an accurate and easy-to-apply method for C2TOPI in AAD with complete reduction.
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Affiliation(s)
- Lijun Lin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Meisong Zhu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Peng Peng
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China
| | - Xintao Zhang
- Department of Radiology, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshandadao Xi, Tianhe District, Guangzhou, Guangdong, China
| | - Xiaoqi Zhou
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China. .,Nanhai Hospital, Southern Medical University, 28 Liguan Road, Lishui Town, Nanhai District, Foshan, Guangdong, China.
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