A medium invasiveness multi-level patient’s specific template for pedicle screw placement in the scoliosis surgery

Abstract

BackgroundSeveral methods including free-hand technique, fluoroscopic guidance, image-guided navigation, computer-assisted surgery system, robotic platform and patient’s specific templates are being used for pedicle screw placement. These methods have screw misplacements and are not always easy to be applied. Furthermore, it is necessary to expose completely a large portions of the spine in order to access fit entirely around the vertebrae.MethodsIn this study, a multi-level patient’s specific template with medium invasiveness was proposed for pedicle screw placement in the scoliosis surgery. It helps to solve the problems related to the soft tissues removal. After a computer tomography (CT) scan of the spine, the templates were designed based on surgical considerations. Each template was manufactured using three-dimensional printing technology under a semi-flexible post processing. The templates were placed on vertebras at four points—at the base of the superior-inferior articular processes on both left–right sides. This helps to obtain less invasive and more accurate procedure as well as true-stable and easy placement in a unique position. The accuracy of screw positions was confirmed by CT scan after screw placement.ResultsThe result showed the correct alignment in pedicle screw placement. In addition, the template has been initially tested on a metal wire series Moulage (height 70 cm and material is PVC). The results demonstrated that it could be possible to implement it on a real patient.ConclusionsThe proposed template significantly reduced screw misplacements, increased stability, and decreased the sliding & the intervention invasiveness.

Clinical application of 3D printing technology to the surgical treatment of atlantoaxial subluxation in small breed dogs

“…Among the 18 dogs that underwent surgery, 15 (83.3%) exhibited clinical benefits at the mid-term follow up evaluation; therefore, the success rate of our surgical technique was at least similar, if not superior, to those of previous studies utilizing other surgical techniques for AAI stabilization [3, 4, 7, 10]. Similar technology has already been investigated in the area of orthopedics [15] [16], oral-facial surgery [17–19], and neurosurgery [20, 21] for the patient-specific manufacture of surgery guides and implants. In veterinary literature, investigation of patient-specific 3D printed drill guide for placement of cervical transpedicular screws was reported most recently [22].…”

Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

“…In our review, 3DP applications, including 3DP screw guides and planning models, have resulted in statistically decreased operative durations and increased pedicle screw placement accuracy. 1,18,19,28,31 Compared with conventional imaging (eg, intraoperative fluoroscopy), 3DP screw placement guides provide improved screw placement accuracy rates, 19,20,[31][32][33][34][35] and models enhance intrateam communication and planning, 21,[23][24][25]28,36 and reduced fluoroscopy time. 19,20 In one retrospective study of 126 adolescent idiopathic scoliosis patients with a Lenke 1 deformity, Yang et al 1 showed that 3DP models used for surgical planning resulted in reduced operative duration and blood loss.…”

Application of three-level navigation template in surgery for hemivertebrae in adolescents

“…Эти свойства модели в значительной степени определяются субъективными впечатлениями, для объективизации которых необходимо проведение опросного исследования. Имеются указания на такой недостаток навигационного шаблона, как необходимость тщательного скелетирования задних структур позвонков, что приводит к большей крово-потере и травматизации тканей [29]. Вместе с тем планирование артродезирующей операции само по себе требует скелетирования задних структур как одного из условий формирования полноценного локального костного блока.…”

“…Таким образом, при транспедикулярной фиксации в маломобильной зоне предпочтительно использование единого навигационного шаблона, что позволяет более надежно позиционировать опорную площадку, а также минимизировать затраты времени, связанные с последовательной установкой нескольких шаблонов. В свою очередь, применение многоуровневого шаблона, состоящего из нескольких опорных площадок, соединенных гибкими вставками, представляется излишним [29].…”