Clinical Application of a Drill Guide Template for Pedicle Screw Placement in Severe Scoliosis

Abstract

Objective: To evaluate the accuracy and the effect of drill guide template for pedicle screw placement in severe scoliosis. Method: Eight patients with rigid scoliosis were enrolled, five males and three females, ranging from nine to 23 years old. A three-dimensional CT scan of the spine was performed and saved as a DICOM file type. The multi-level template was designed by Mimics software and manufactured according to the part of the most severe deformity. The drill template was placed on the corresponding vertebral surface. Pedicle screws were carefully inserted across the trajectory of the template. Postoperatively, the positions of the pedicle screws were evaluated by CT scan and graded for validation. Results: No spinal cord injury or nerve damage occurred. All patients had satisfactory outcomes. The abnormalities and the measures observed during operation were the same as those found in the preoperative period. The position of the pedicle screws was accurate, according to the postoperative X-ray and CT scan. The rate of scoliosis correction was 60%. Compared with controls, surgery time, blood loss and radiation were significantly lower. Conclusion: With the application of multi-level template, the placement of pedicle screws shows high accuracy in scoliosis with shorter surgical time, less blood loss and less radiation exposure. Level of Evidence III, Retrospective Comparative Study.

Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

“…This tool was then further developed, which improved accuracy rates of pedicle screw insertion. [25][26][27][28] Although some reports have revealed no clear differences comparing the freehand technique with the custom-made guide technique to implant pedicle screws, 23 the template guides have become a well-established and useful tool in spine deformity surgery 29,30 after several cadaveric studies. 31 In 2017, Farshad et al 32 compared time of instrumentation, accuracy, and radiation exposure between patient-specific template-guided and freehand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine, assessing the superiority of template-guided positioning.…”

Clinical applications and prospects of 3D printing guide templates in orthopaedics

“… 2017 Li X et al. [ 113 ] Acta Ortop Bras 8 Pedicle screws fixation rigid scoliosis The placement of pedicle screws shows high accuracy in scoliosis with shorter surgical time, less blood loss, and less radiation exposure. 2017 Liu K et al.…”

“…Li et al. [ 113 ] retrospectively analyzed sixteen patients and found that the position of the pedicle screws was more accurate if using the template. Cecchinato et al.…”

Incidencia de la exposición a los rayos X en cirugías de columna. [Incidence of X-rays exposure in spinal surgeries.]

“…10 En China, en un gesto para disminuir el riesgo de exposición a la radiación, se utilizó el prototipado rápido asistido por computadora, que consiste en simular una operación por computadora utilizando un esquema de diseño y planificación quirúrgicos que muestra los resultados del procedimiento, en el que se realiza la cirugía virtual y se definen la ubicación, el diámetro, la dirección de profundidad de los tornillos pediculares y así se evitan los órganos neurovasculares y se asegura la correcta colocación de los tornillos pediculares diseñados. 11 En un estudio comparativo de descompresión posterior mínimamente invasiva combinada con la fijación de tornillos pediculares percutáneos y la cirugía posterior abierta para tratar fracturas toracolumbares, se observó que la exposición a la radiación y el tiempo operatorio fueron mayores en el primer grupo. 12 Así mismo, la discectomía lumbar endoscópica transforaminal es un método asistido por ecografía que requirió significativamente menos tiempo de radioscopia al compararla con el disectomía lumbar percutánea asistida por radioscopia.…”