Accuracy of Lumbosacral Pedicle Screw Placement in Dogs: A Novel 3D Printed Patient-Specific Drill Guide versus Freehand Technique in Novice and Expert Surgeons

Abstract

Objective The aim of this study was to compare the accuracy of pedicle screw placement at the canine lumbosacral junction using a novel unilateral three-dimensional printed patient-specific guide (3D-PSG) versus a freehand drilling technique. Additionally, accuracy of screw placement between a novice and an experienced surgeon was determined. Study Design Preoperative computed tomography images from 20 lumbosacral cadaveric specimens were used to design a novel unilateral 3D-PSG for the L7 and sacral vertebrae which was printed in acryl-nitrile butadiene styrene plastic. A novice and an expert surgeon each placed 3.5mm cortical screws in 10 cadavers; on the left using the unilateral 3D-PSG and by the freehand (anatomic landmark) technique on the right. Results Sixty screws were placed using the unilateral 3D-PSG and 60 using the freehand technique. There was no statistical difference in accuracy for the comparison between methods performed by the expert (p = 0.679) and novice (p = 0.761) surgeon, nor between an expert and novice surgeon overall (p = 0.923). Unexpectedly, the use of a unilateral 3D-PSG increased variability for the expert surgeon in our study (p = 0.0314). Conclusion Using a novel unilateral 3D-PSG did not improve the accuracy of screw placement for lumbosacral stabilization by a novice surgeon compared with an expert surgeon in lumbar spine surgery. This may reflect a suboptimal PSG design.

Performances of novel custom 3D-printed cutting guide in canine caudal maxillectomy: a cadaveric study

“…Surgical approach and management of hemorrhage, however, are essential aspects of the procedure that are not exemplified by the guide. Few previous veterinary studies compared the accuracy obtained with the use of 3D-printed custommade surgical guides from an experienced to a novice surgeon in corrective osteotomy and pedicle screw placement; no difference in accuracy was noted between the experienced and novice users in those scenarios (29,37,38). In the human literature, implant placement accuracy using 3D-printed custom-made surgical guides revealed no difference in accuracy between the experienced and novice surgeons in periodontal patients (39).…”

Accuracy of CAD/CAM and 3D printing in the treatment of feline femoral neck fracture

“…Stworzone prowadnice wiertła umożliwiły wprowadzenie wkrętów w osi szyjki kości udowej we wszystkich badanych modelach. Wiercenie otworów przy użyciu prowadnic zaprojektowanych do przeprowadzenia konkretnej operacji cechuje się bardzo wysoką skutecznością wywiercenia otworu w pożądanym miejscu i pod zaplanowanym kątem (2,9,15). Użycie takich narzędzi pozwala na osiągnięcie znacznie lepszych wyników w porównaniu z wierceniem bez dodatkowych narzędzi, czy wierceniem pod kontrolą fluoroskopową (9).…”

“…CAD/CAM umożliwia tworzenie prototypowych narzędzi chirurgicznych, np. prowadnic wiertła (1,2,9,15), oraz skomplikowanych modeli anatomicznych naturalnej wielkości. To pozwala na wirtualne zaplanowanie operacji, a następnie wykonanie jej na wydrukowanym modelu.…”

Ex vivo comparison of pin placement with patient‐specific drill guides or freehand technique in canine cadaveric spines

“…[34][35][36][37][38] Computed-tomography-based CAD/CAM technology for the development of patient-specific drill guides has been shown to have increased accuracy and safety during vertebral implant placement in humans when compared to the conventional freehand technique. 25,35,38 The use of 3D-printed guides in a variety of applications to the canine spine has been previously reported, both in a clinical setting and in cadavers, and is associated with a very high degree of accuracy [39][40][41][42][43][44][45][46][47][48][49][50][51] However, in many of these studies, implant placement was performed by only one or two surgeons with experience in spinal stabilization. The objective of this study was to compare the placement of vertebral implants between patient-specific drill guides and the freehand technique in surgeons with varying levels of experience.…”

“…The use of 3D‐printed guides in a variety of applications to the canine spine has been previously reported, both in a clinical setting and in cadavers, and is associated with a very high degree of accuracy 39–51 However, in many of these studies, implant placement was performed by only one or two surgeons with experience in spinal stabilization. The objective of this study was to compare the placement of vertebral implants between patient‐specific drill guides and the freehand technique in surgeons with varying levels of experience.…”