Accuracy and safety of cortical bone trajectory screw placement by an inexperienced surgeon using 3D patient-specific guides for transforaminal lumbar interbody fusion

Maruo, Keishi; Arizumi, Fumihiro; Kusuyama, Kazuki; Kishima, Kazuya; Tachibana, Tetsuya

doi:10.1016/j.jocn.2020.04.090

Cited by 8 publications

(12 citation statements)

References 18 publications

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“…In addition, the height of the arch can be designed according to the thickness of the supraspinous ligament, enabling the 3D navigation template to straddle the spinous process and the supraspinous ligament above it. This helps to maintain distance with the supraspinous ligament; thus, the bottom of the side arms of the template can be well attached to the surface of the vertebral plate, rather than suspended (22,25). Third, it was found that, due to the small size of the 3D navigation template, during intraoperative guiding, it was not convenient for the surgeon or assistant to hold the template for a long time, and the rotation of the drill may change its direction at any time.…”

Section: Discussionmentioning

confidence: 99%

“…After 40 screw placements in two groups, all except one screw on one human anatomical specimen were completely placed inside the vertebral canal; none of the remaining screws were found broken in the inner and outside arm of the pedicle. Although the placement of screws using the 3D template encountered challenges, the operation, performed by junior spine surgeons at medical university without any related experience ( 22 ), required only half or even less time than that of experienced clinicians with the assistance of x-ray, suggesting great potential practical application value in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine

Shi

Aini²,

Dang³

et al. 2022

Front. Surg.

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ObjectivesCompared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof.MethodsFour human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement.ResultsTwenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively.ConclusionsWe report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine

Shi

Aini²,

Dang³

et al. 2022

Front. Surg.

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“…Consequently, extended periods of anesthesia and rates of infections were greatly reduced 57,58 . Another retrospective analysis of 30 patients by Maruo et al found that the use of 3D-printed guides for CBT by a surgeon "inexperienced" in the CBT technique increased the accuracy of CBT screw placement to 97% from 91% 59 .…”

Section: Evolution Of Technique and Directions For The Futurementioning

confidence: 99%

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

Kim¹,

Mobbs²,

Natarajan³

et al. 2022

Spine Surg Relat Res

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was the principal author, responsible for conducting the literature review and writing the primary manuscript. R.J. Mobbs provided the direction for the paper, provided a clinical background to CBT and the figures displayed in this manuscript, and revised the first manuscript. P. Natarajan and R.D. Fonseka assisted with data/literature collection and provided revisions of the final manuscript. W.R. Walsh provided biomechanical background to the CBT to the primary author and reviewed the final manuscript. Ethics ApprovalNo ethics approval was not required as this was a historical review paper and did not require (1) biomechanical testing using cadaveric/animal specimen or (2) any clinical participants.

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“…[3]. Due to the difference from the traditional PS trajectory, computer-assisted devices such as navigation [4][5][6][7] and three-dimensional (3D)-printed templates [8][9][10][11] are being used. Furthermore, recently, robotic-assisted spine surgery has been performed, which is expected to contribute to improving the safety of the CBT screw [12][13][14][15][16].…”

mentioning

confidence: 99%

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

Ueno¹,

Akazawa²,

Torii³

et al. 2022

Cureus

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The purpose of this study was to evaluate robotic-assisted cortical bone trajectory (CBT) screw placement. Early, middle, and late phases of robotic-assisted CBT screw placement were compared for accuracy and screw insertion time by comparing time and accuracy in every phase. MethodsA retrospective review was conducted on the initial 40 patients who underwent spinal fusion using CBT screws in one institution from September 2021 to September 2022 utilizing a spine surgery robot system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland). The inclusion criterion was one-or two-level posterior lumbar interbody fusion (PLIF). Exclusion criteria were 1) patients who underwent posterior-lateral fusion in other segments, 2) patients who underwent additional decompression in other segments, 3) patients who underwent reoperation, and 4) patients with spondylolysis. The deviation of the CBT screw was evaluated on computed tomography (CT) one week after surgery using the Gertzbein-Robbins grade system. The rate of Grade A was considered the perfect accuracy rate, and the rate of penetration of 2 mm or more (Grades C, D, and E) was calculated as the deviation rate. To assess the learning curve, patients were divided into three groups. The first 10 cases were in the early phase group, the subsequent 10 cases were in the middle phase group, and the last 10 cases were in the late phase group. We compared the perfect accuracy rate, deviation rate, operative time, operative time per segment, intraoperative blood loss, registration time, and screw insertion time among the three groups. ResultsThirty patients met the criteria. Overall, the perfect accuracy (Grade A) rate of the screw was 95.3% and the deviation rate was 1.4%. The perfect accuracy rate was 90.4% in the early phase, 95.5% in the middle phase, and 100% in the late phase. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase, and there was no statistically significant difference between the three groups. Among the three groups, the operative time, the operative time per segment, the intraoperative blood loss, and the registration time were not significantly different. There was no significant difference in the screw insertion time among the three groups, but it decreased with experience (early phase: 156.9 ± 54.7 sec, middle phase: 139.9 ± 41.6 sec, and late phase: 106.4 ± 39.9 sec, p=0.060). The screw insertion time of the late phase tended to be shorter than that of the early phase (p=0.052). ConclusionsThe deviation rate of robotic-assisted CBT screw placement with one-or two-level PLIF was 1.4%, which was highly accurate. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase. Although the deviation rate was low even in the early period, the screw insertion time in the early 10 cases tended to be longer than that in the late 10 cases. After passing the experience of 10 cases, this study concluded that robotic-assisted CBT screw placement was proficient.

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Accuracy and safety of cortical bone trajectory screw placement by an inexperienced surgeon using 3D patient-specific guides for transforaminal lumbar interbody fusion

Cited by 8 publications

References 18 publications

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

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