Accuracy Assessment of Pedicle and Lateral Mass Screw Insertion Assisted by Customized 3D-Printed Drill Guides: A Human Cadaver Study

Pijpker, Peter A J; Kraeima, Joep; Witjes, Max J. H.; Oterdoom, D L Marinus; Coppes, Maarten H.; Groen, Rob J. M.; Kuijlen, Jos M. A.

doi:10.1093/ons/opy060

Cited by 17 publications

(22 citation statements)

References 21 publications

(30 reference statements)

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“…Similarly, improved transverse (2.4° and 4.0°) and sagittal (1.8° and 1.6°) angle placements were obtained in both nonscoliosis and scoliosis models, respectively, when guides were used (Tables 1 and 2). These findings were consistent with those of previous templates showing 0.66 to 1.2 mm deviations in the mean entry point as well as 1.7° to 4.8° and 1.3° to 2.4° deviations in the sagittal and transverse planes, respectively [13,18-19,23]. In accordance, the Gertzbein-Robbins scale indicated significant improvements in the PS placements when template guides were used; 93.5% and 71.7% success rate (ie, sum of screws in grades 0 and A) in the guided and freehand approaches, respectively (Table 3).…”

Section: Discussionsupporting

confidence: 93%

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

Ashouri-Sanjani

Mohammadi-Moghadam

Azimi

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Pedicle screw (PS) placement has been widely used in fusion surgeries on the thoracic spine. Achieving cost-effective yet accurate placements through nonradiation techniques remains challenging. Questions/Purposes: Novel noncovering lock-mechanism bilateral vertebra-specific drill guides for PS placement were designed/fabricated, and their accuracy for both nondeformed and deformed thoracic spines was tested. Methods: One nondeformed and 1 severe scoliosis human thoracic spine underwent computed tomographic (CT) scanning, and 2 identical proportions of each were 3-dimensional (3D) printed. Pedicle-specific optimal (no perforation) drilling trajectories were determined on the CT images based on the entry point/orientation/diameter/length of each PS. Vertebra-specific templates were designed and 3D printed, assuring minimal yet firm contacts with the vertebrae through a noncovering lock mechanism. One model of each patient was drilled using the freehand and one using the template guides (96 pedicle drillings). Postoperative CT scans from the models with the inserted PSs were obtained and superimposed on the preoperative planned models to evaluate deviations of the PSs. Results: All templates fitted their corresponding vertebra during the simulated operations. As compared with the freehand approach, PS placement deviations from their preplanned positions were significantly reduced: for the nonscoliosis model, from 2.4 to 0.9 mm for the entry point, 5.0° to 3.3° for the transverse plane angle, 7.1° to 2.2° for the sagittal plane angle, and 8.5° to 4.1° for the 3D angle, improving the success rate from 71.7% to 93.5%. Conclusions: These guides are valuable, as the accurate PS trajectory could be customized preoperatively to match the patients’ unique anatomy. In vivo studies will be required to validate this approach.

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Section: Discussionsupporting

confidence: 93%

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

Ashouri-Sanjani

Mohammadi-Moghadam

Azimi

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…Based on the defined trajectories, pedicle drill guides were tailored to the patients’ anatomy according to our previously presented design blueprints and adjusted to the available drilling equipment (Figure 3 ). 11 Then, Occipital Plate Rods (Vertex Max, Medtronic, Dublin, Ireland) were CT scanned in order to obtain a 3D model needed for 3D planning. The occipital bone thickness was visualized using a colored heatmap and the plate was virtually positioned, aiming for screw regions with maximum bone thickness (Figure 4 A and 4B ).…”

Section: Methodsmentioning

confidence: 99%

Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient With Occipitocervical Instability

Pijpker

Kuijlen

Kaptein

et al. 2021

ONSURG

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BACKGROUND Pediatric occipitothoracic fusion can be challenging because of small size pedicles and thin occipital bone. Three-dimensional (3D) printing technology can help with accurate screw insertion but has not been described for occipital keel plate positioning so far. OBJECTIVE To describe the novel use of 3D technology to position occipital keel plates during pediatric occipitothoracic fixation. METHODS A young boy with segmental spinal dysgenesis presented with asymmetrical pyramidal paresis in all limbs. Developmental abnormities of the cervical spine caused a thinned spinal cord, and because of progressive spinal cord compression, surgical intervention by means of occipitothoracic fixation was indicated at the age of 3 yr. Because of the small-size pedicles and thin occipital bone, the pedicle screws and occipital plates were planned meticulously using 3D virtual surgical planning technology. The rods were virtually bent in order to properly align with the planned screws. By means of 3D-printed guides, the surgical plan was transferred to the operating theater. For the occipital bone, a novel guide concept was developed, aiming for screw positions at maximal bone thickness. RESULTS The postoperative course was uneventful, and radiographs showed good cervical alignment. After superimposing the virtual plan with the intraoperative acquired computed tomography, it was confirmed that the occipital plate positions matched the virtual plan and that pedicle screws were accurately inserted without signs of breach. CONCLUSION The use of 3D technology has greatly facilitated the performance of the occipitothoracic fixation and could, in the future, contribute to safer pediatric spinal fixation procedures.

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“…1). A human cadaver or spine specimen study revealed that 3Dprinted patient-specific navigation template for screw placement improved safety and yielded excellent drilling accuracy [6][7]39] . The "gold standard" for estimating the accuracy of the guide plate is the overlap between the preoperative planning and actual postoperative screw position.…”

Section: D Printing Surgical Guide Template 121 3d-printed Jigs For Pedicle Screw Placementmentioning

confidence: 99%

“…This new technology can efficiently convert digital 3D model information, such as that in standard tessellation language (STL) files, into physical objects. Due to its advantages in design and manufacturing, 3D printing has been adopted in a vast range of applications in spine surgery, including producing anatomical models [1][2][3] , surgical templates [4][5][6][7][8] , preoperative planning [9][10][11] , and patient-specific spinal implants [12][13][14][15][16][17][18][19] . In addition to its advantages in manufacturing anatomically adapted implants, 3D printing technology is also being used to optimise the structural properties of premade off-theshelf medical products [20] .…”

Section: Introductionmentioning

confidence: 99%

Progress in the Application of 3D Printing Technology in Spine Surgery

Sun

Yang

Zhao

et al. 2021

J. Shanghai Jiaotong Univ. (Sci.)

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We are in the midst of exciting advancements in new technologies and innovative research in precision medicine. Among these, 3D printing is one of the most frequently seen in clinical orthopaedic settings. This new technique has been adopted in a vast range of applications in spine surgery, such as producing anatomical models, surgical templates, preoperative plans, and spinal implants. Some studies on 3D printing technologies in spine surgery have reported the benefits of this emerging technology with more effective manufacturing, more visualisation for communication, and more precise navigation for screw insertion and osteotomy. In addition, in customised implant design and fabrication processes, 3D printing products with anatomical adaptions and complex porous microstructure show some attractive advantages in terms of fit and osteoinductivity. However, there are still some concerns about the safety and feasibility of the application of 3D printing technology in spine surgery. We review the literature on and share our experiences with the application of 3D printing from the beginning of collaborations between doctors and computer-aided design (CAD) designers to the final follow-up of clinical patients.

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Accuracy Assessment of Pedicle and Lateral Mass Screw Insertion Assisted by Customized 3D-Printed Drill Guides: A Human Cadaver Study

Abstract: The study ultimately resulted in an advanced guide design including caudally positioned hooks, crosslink support structure, and metal inlays. The novel advanced drill guide design yields excellent drilling accuracy.

Cited by 17 publications

References 21 publications

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient With Occipitocervical Instability

Progress in the Application of 3D Printing Technology in Spine Surgery

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