3D Printed Templates Improve the Accuracy and Safety of Pedicle Screw Placement in the Treatment of Pediatric Congenital Scoliosis

Abstract

Background: Three-dimensional (3-D) printed guidance templates are being increasingly used in spine surgery. The purpose of this study was to determine if 3D printed navigation templates can improve the accuracy of pedicle screw placement and decrease the complication rate compared to freehand screw placement in the treatment of children with congenital scoliosis. Methods: The records of pediatric patients with congenital scoliosis treated at our hospital from January 2017 to January 2019 were retrospectively reviewed. Patients were divided into those where a 3D printed guidance templated was used and those in which the freehand method was used for pedicle screw placement. The accuracy rate of pedicle screw placement, surgical outcomes, and complications were compared between groups.Results: A total of 67 children with congenital scoliosis were included (43 males and 24 females; mean age of 4.13 ± 2.66 years; range, 2-15 years). There were 34 children in the template-assisted group and 33 in the freehand group. The excellent accuracy rate of pedicle screw placement was significantly higher in the template-assisted group (96.10% vs. 88.64%, P = 0.007). The main Cobb angle and kyphosis angle were similar between the 2 groups preoperatively and postoperatively (all, P > 0.05), and in both groups both angles were significantly decreased after surgery as compared to the preoperative values (all, P < 0.001). The degree of change of the Cobb angle of the main curve and kyphosis angle were not significantly different between the 2 groups. There were no postoperative complications in the template group and 4 in the freehand group (0% vs. 12.12%; P = 0.009). All 4 patients with complications required revision surgery.

Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis

“…Another 191 irrelevant articles were excluded after a screening the study titles and abstracts. Only 7 articles 13,[17][18][19][20][21][22] were found to be eligible for this meta-analysis after the exclusion of 18 case reports.…”

“…Pedicle screw placement is essential for all spinal diseases requiring posterior correction with internal fixation (including degeneration, deformity, trauma, tumor, infection, etc.). The most commonly used screw placement methods at present are the freehand technique, 3D-printed navigation Cao et al 22 Garg et al 18 Liu et al 13 Luo et al 19 Pan et al 20 Tu et al 21 template-assisted screw placement, computer navigationassisted screw placement, etc. Of these, the 3D-printed navigation template-assisted screw placement technique is growing in popularity in the field of spinal surgery [23][24][25] due to its application toward individualization and precision.…”

“…Data on complication rates were reported in four studies. 18,19,21,22 A fixed-effect model was used to summarize the results because little heterogeneity was found among the four studies (I 2 ¼ 0%; p ¼ 0.69). Compared with the freehand technique group, the 3D-printed navigation template group showed a lower incidence of complications (OR ¼ 0.21; 95% CI: 0.06-0.78; p ¼ 0.02; ►Fig.…”

“…Five studies [18][19][20][21][22] reported data on the operation time. Since moderate heterogeneity was found among these studies, a random-effect model was used to summarize the results (I 2 ¼ 78%; p ¼ 0.001).…”

“…All studies 13,[17][18][19][20][21][22] reported the accuracy of pedicle screw placement. After the assessment, no heterogeneity was found in these studies (I 2 ¼ 6%; p ¼ 0.38), so the results were summarized using a fixed-effects model.…”